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Irrigated radiofrequency ablation is a successful treatment option in atrial fibrillation (AF). Type and level of contact force (CF) are critical for energy transmission. Outcome data comparing continuous and limited vs. CF guided wall contact are lacking.
Forty patients were studied. 20 consecutive patients (14 male, 65±8 years) underwent antral RFC pulmonary vein isolation (PVAI) (40-50W, 48C, 15-20 s, 30mL/min flow) for persistent (14) or paroxysmal (6) AF guided by CF (Tacticath, Endosense). An average CF of >15 g was aimed (group 1). Patients were matched to 20 patients treated by magnetically directed (Stereotaxis Niobe) irrigated gold-tip (Trignum G, Biotronik) (MDG) ablation (group 2) at a similar energy protocol for PVAI. Patients were followed by clinical visits and 7 day Holters at 3, 6, 9, 12, 18, 24 month post ablation including a 3 month blanking-interval.
All targeted pulmonary veins could be isolated confirmed by entrance block in both groups. Procedure time was 185.6±55.6 min (group 1) and 210.2±55.5 min (group 2) (p=0.19). Patients’ radiation exposure and fluoroscopy times were 6823±3227pGy*m2, 37.9±17.4 min and 5323.1±2940.2pGy*m2, 24.4±12.0 min (p=0.15; p=0.01) respectively. Ablation time was 1927±678 s (group 1) and 3338±1158 s (group 2) (p=0.001). Mean CF was 19.4±6.4 g, total force-time-integral (FTI) 33347±12444 gs and average FTI/ablation 1177±405 gs (group 1).
Two pericardial tamponades and 2 audible steam-pops occurred in group 1, no procedural complications were observed in group 2 (p=0.15). Success rates were 70% (14 /20) and 65% (13 /20) (p=1.0) in a 19.8±2.8 and 21.1±5.9 month follow-up. Average FTI was 1257±413 gs in patients without and 854±106 gs (p=0.02) with recurrent AF.
From our preliminary experience, CF guided and MDG ablation seem to be equally effective for PVAI in a mid-term follow-up. CF guided PVAI showed a trend to a higher incidence of side effects and may be improved by an optimized average FTI/ablation. However, MDG shows a tendency to longer procedure times and requires longer ablation times compared to CF guided ablation.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias: AF/SVT VII
Abstract Category: 4. Arrhythmias: AF/SVT
Presentation Number: 1236-33
- 2013 American College of Cardiology Foundation