TY - JOUR
T1 - Acute Pulmonary Vein Reconnection After Ablation using Contact-Force Sensing Catheters
T2 - Incidence, Timing, and Ablation Lesion Characteristics
AU - Balouch, Muhammad
AU - Juang, Dong
AU - Sivasambu, Bhradeev
AU - Bajwa, Rizma J.
AU - Zghaib, Tarek
AU - Chrispin, Jonathan
AU - Berger, Ronald D.
AU - Ashikaga, Hiroshi
AU - Calkins, Hugh
AU - Marine, Joseph E.
AU - Spragg, David D.
N1 - Funding Information:
Funding for this research was provided in part by the Edward St. John Fund for AF Research, The Roz and Marvin H Weiner and Family Foundation,The Dr. Francis P. Chiaramonte Foundation,The Marilyn and Christian Poindexter Arrhythmia Research Fund, The Norbert and Louise Grunwald Cardiac Arrhythmia Research Fund and Mr and Mrs Larry Small AF Research Fund.
Publisher Copyright:
© 2018 CardioFront LLC. All Rights Reserved.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2018/8/1
Y1 - 2018/8/1
N2 - Background: Acute pulmonary vein (PV) reconnection predicts atrial fibrillation (AF) recurrence after ablation. Contact-force (CF) sensing catheters improve lesion delivery. We assessed the incidence, timing, location, and lesion characteristics of acute reconnection after PV isolation with CF sensing catheters. Methods: Patients undergoing radiofrequency ablation for AF from October 2016 to February 2017 were studied. Assessment for acute reconnection at 20 and 40 minute intervals was performed in each isolated PV. Additional lesions were applied as needed. Lesion location, contact force, power, duration, impedance, and force-time integral values were compared at sites with and without reconnection. Results: Twenty-two patients (60.6 + 1.8 years; 36.4% female; 27.3% persistent AF; CHA2DS2VASC 1.9 + 0.3) were included. Eighty-eight veins were isolated. Eleven reconnections occurred in 10 patients; 9 occurred by 20 minutes and 2 between 20-40 minutes. Most reconnections (6/11) were in the left superior PV. Of 4993 ablation points analyzed, 72 were at acute reconnection sites, and no differences in average contact force (11.4 + 8.1 vs 11.3 + 7.1 gm, p=0.868), power (29.7 + 3.9 vs 29.9 + 4.6 watts, p=0.620), impedance (64.1 + 60 vs 72.5 + 60, p=0.236) and the force time integral (86.9 + 78.8 vs 99.7 + 100 gm/sec, p=0.282) were found. Conclusion: Acute PV reconnection rates using CF sensing catheters are roughly 12.5%, with the majority occurring within 20 minutes. We found no significant differences in characteristics of ablation points in areas of reconnection. Optimum wait periods after isolation to check for acute reconnection may be as brief as 20 minutes.
AB - Background: Acute pulmonary vein (PV) reconnection predicts atrial fibrillation (AF) recurrence after ablation. Contact-force (CF) sensing catheters improve lesion delivery. We assessed the incidence, timing, location, and lesion characteristics of acute reconnection after PV isolation with CF sensing catheters. Methods: Patients undergoing radiofrequency ablation for AF from October 2016 to February 2017 were studied. Assessment for acute reconnection at 20 and 40 minute intervals was performed in each isolated PV. Additional lesions were applied as needed. Lesion location, contact force, power, duration, impedance, and force-time integral values were compared at sites with and without reconnection. Results: Twenty-two patients (60.6 + 1.8 years; 36.4% female; 27.3% persistent AF; CHA2DS2VASC 1.9 + 0.3) were included. Eighty-eight veins were isolated. Eleven reconnections occurred in 10 patients; 9 occurred by 20 minutes and 2 between 20-40 minutes. Most reconnections (6/11) were in the left superior PV. Of 4993 ablation points analyzed, 72 were at acute reconnection sites, and no differences in average contact force (11.4 + 8.1 vs 11.3 + 7.1 gm, p=0.868), power (29.7 + 3.9 vs 29.9 + 4.6 watts, p=0.620), impedance (64.1 + 60 vs 72.5 + 60, p=0.236) and the force time integral (86.9 + 78.8 vs 99.7 + 100 gm/sec, p=0.282) were found. Conclusion: Acute PV reconnection rates using CF sensing catheters are roughly 12.5%, with the majority occurring within 20 minutes. We found no significant differences in characteristics of ablation points in areas of reconnection. Optimum wait periods after isolation to check for acute reconnection may be as brief as 20 minutes.
KW - Atrial fibrillation ablation
KW - Contact-force sensing catheter
KW - PV reconnection
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M3 - Article
AN - SCOPUS:85056625096
SN - 1941-6911
VL - 11
JO - Journal of Atrial Fibrillation
JF - Journal of Atrial Fibrillation
IS - 2
ER -