Contact force sensing for ablation of persistent atrial fibrillation: A randomized, multicenter trial

Sergio Conti, Rukshen Weerasooriya, Paul Novak, Jean Champagne, Hong Euy Lim, Laurent Macle, Yaariv Khaykin, Alfredo Pantano, Atul Verma

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background Impact of contact force sensing (CFS) on ablation of persistent atrial fibrillation (PeAF) is unknown. Objective The purpose of the TOUCH AF (Therapeutic Outcomes Using Contact force Handling during Ablation of Persistent Atrial Fibrillation) randomized trial was to compare CFS-guided ablation to a CFS-blinded strategy. Methods Patients (n = 128) undergoing first-time ablation for persistent AF were randomized to a CFS-guided vs CFS-blinded strategy. In the CFS-guided procedure, operators visualized real-time force data. In the blinded procedure, force data were hidden. Wide antral pulmonary vein isolation plus a roof line were performed. Patients were followed at 3, 6, 9, and 12 months with clinical visit, ECG, and 48-hour Holter monitoring. The primary endpoint was cumulative radiofrequency (RF) time for all procedures. Atrial arrhythmia >30 seconds after 3 months was a recurrence. Results PeAF was continuous for 26 weeks (interquartile range [IQR] 13–52), and left atrial size was 45 ± 5 mm. Force in the CFS-blinded and CFS-guided arms was 12 g [IQR 6–20] and 14 g [IQR 9–20] (P =.10), respectively. Total RF time did not differ between CFS-guided and CFS-blinded groups (49 ± 14 min vs 50 ± 20 min, respectively; P =.70). Single procedure freedom from atrial arrhythmia was 60% in the CFS-guided arm and 63% in the CFS-blinded arm off drugs. Lesions with gaps were associated with significantly less force (11.4 g [IQR 6–19] vs 13.2 g [IQR 8–20], respectively; P =.0007) and less force-time integral (174 gs [IQR 91–330] vs 210 gs [IQR 113–388], respectively; P <.001). Conclusion CFS-guided ablation resulted in no difference to RF time or 12-month outcome. Lower force/force-time integral was associated with significantly more gaps.

Original languageEnglish
Pages (from-to)201-208
Number of pages8
JournalHeart Rhythm
Volume15
Issue number2
DOIs
Publication statusPublished - 2018 Feb 1
Externally publishedYes

Fingerprint

Atrial Fibrillation
Multicenter Studies
Cardiac Arrhythmias
Ambulatory Electrocardiography
Pulmonary Veins
Electrocardiography
Recurrence
Pharmaceutical Preparations

Keywords

  • Ablation
  • Contact force
  • Persistent atrial fibrillation
  • Pulmonary vein isolation
  • Trial

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Conti, S., Weerasooriya, R., Novak, P., Champagne, J., Lim, H. E., Macle, L., ... Verma, A. (2018). Contact force sensing for ablation of persistent atrial fibrillation: A randomized, multicenter trial. Heart Rhythm, 15(2), 201-208. https://doi.org/10.1016/j.hrthm.2017.10.010

Contact force sensing for ablation of persistent atrial fibrillation : A randomized, multicenter trial. / Conti, Sergio; Weerasooriya, Rukshen; Novak, Paul; Champagne, Jean; Lim, Hong Euy; Macle, Laurent; Khaykin, Yaariv; Pantano, Alfredo; Verma, Atul.

In: Heart Rhythm, Vol. 15, No. 2, 01.02.2018, p. 201-208.

Research output: Contribution to journalArticle

Conti, S, Weerasooriya, R, Novak, P, Champagne, J, Lim, HE, Macle, L, Khaykin, Y, Pantano, A & Verma, A 2018, 'Contact force sensing for ablation of persistent atrial fibrillation: A randomized, multicenter trial', Heart Rhythm, vol. 15, no. 2, pp. 201-208. https://doi.org/10.1016/j.hrthm.2017.10.010
Conti, Sergio ; Weerasooriya, Rukshen ; Novak, Paul ; Champagne, Jean ; Lim, Hong Euy ; Macle, Laurent ; Khaykin, Yaariv ; Pantano, Alfredo ; Verma, Atul. / Contact force sensing for ablation of persistent atrial fibrillation : A randomized, multicenter trial. In: Heart Rhythm. 2018 ; Vol. 15, No. 2. pp. 201-208.
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abstract = "Background Impact of contact force sensing (CFS) on ablation of persistent atrial fibrillation (PeAF) is unknown. Objective The purpose of the TOUCH AF (Therapeutic Outcomes Using Contact force Handling during Ablation of Persistent Atrial Fibrillation) randomized trial was to compare CFS-guided ablation to a CFS-blinded strategy. Methods Patients (n = 128) undergoing first-time ablation for persistent AF were randomized to a CFS-guided vs CFS-blinded strategy. In the CFS-guided procedure, operators visualized real-time force data. In the blinded procedure, force data were hidden. Wide antral pulmonary vein isolation plus a roof line were performed. Patients were followed at 3, 6, 9, and 12 months with clinical visit, ECG, and 48-hour Holter monitoring. The primary endpoint was cumulative radiofrequency (RF) time for all procedures. Atrial arrhythmia >30 seconds after 3 months was a recurrence. Results PeAF was continuous for 26 weeks (interquartile range [IQR] 13–52), and left atrial size was 45 ± 5 mm. Force in the CFS-blinded and CFS-guided arms was 12 g [IQR 6–20] and 14 g [IQR 9–20] (P =.10), respectively. Total RF time did not differ between CFS-guided and CFS-blinded groups (49 ± 14 min vs 50 ± 20 min, respectively; P =.70). Single procedure freedom from atrial arrhythmia was 60{\%} in the CFS-guided arm and 63{\%} in the CFS-blinded arm off drugs. Lesions with gaps were associated with significantly less force (11.4 g [IQR 6–19] vs 13.2 g [IQR 8–20], respectively; P =.0007) and less force-time integral (174 gs [IQR 91–330] vs 210 gs [IQR 113–388], respectively; P <.001). Conclusion CFS-guided ablation resulted in no difference to RF time or 12-month outcome. Lower force/force-time integral was associated with significantly more gaps.",
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AU - Champagne, Jean

AU - Lim, Hong Euy

AU - Macle, Laurent

AU - Khaykin, Yaariv

AU - Pantano, Alfredo

AU - Verma, Atul

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N2 - Background Impact of contact force sensing (CFS) on ablation of persistent atrial fibrillation (PeAF) is unknown. Objective The purpose of the TOUCH AF (Therapeutic Outcomes Using Contact force Handling during Ablation of Persistent Atrial Fibrillation) randomized trial was to compare CFS-guided ablation to a CFS-blinded strategy. Methods Patients (n = 128) undergoing first-time ablation for persistent AF were randomized to a CFS-guided vs CFS-blinded strategy. In the CFS-guided procedure, operators visualized real-time force data. In the blinded procedure, force data were hidden. Wide antral pulmonary vein isolation plus a roof line were performed. Patients were followed at 3, 6, 9, and 12 months with clinical visit, ECG, and 48-hour Holter monitoring. The primary endpoint was cumulative radiofrequency (RF) time for all procedures. Atrial arrhythmia >30 seconds after 3 months was a recurrence. Results PeAF was continuous for 26 weeks (interquartile range [IQR] 13–52), and left atrial size was 45 ± 5 mm. Force in the CFS-blinded and CFS-guided arms was 12 g [IQR 6–20] and 14 g [IQR 9–20] (P =.10), respectively. Total RF time did not differ between CFS-guided and CFS-blinded groups (49 ± 14 min vs 50 ± 20 min, respectively; P =.70). Single procedure freedom from atrial arrhythmia was 60% in the CFS-guided arm and 63% in the CFS-blinded arm off drugs. Lesions with gaps were associated with significantly less force (11.4 g [IQR 6–19] vs 13.2 g [IQR 8–20], respectively; P =.0007) and less force-time integral (174 gs [IQR 91–330] vs 210 gs [IQR 113–388], respectively; P <.001). Conclusion CFS-guided ablation resulted in no difference to RF time or 12-month outcome. Lower force/force-time integral was associated with significantly more gaps.

AB - Background Impact of contact force sensing (CFS) on ablation of persistent atrial fibrillation (PeAF) is unknown. Objective The purpose of the TOUCH AF (Therapeutic Outcomes Using Contact force Handling during Ablation of Persistent Atrial Fibrillation) randomized trial was to compare CFS-guided ablation to a CFS-blinded strategy. Methods Patients (n = 128) undergoing first-time ablation for persistent AF were randomized to a CFS-guided vs CFS-blinded strategy. In the CFS-guided procedure, operators visualized real-time force data. In the blinded procedure, force data were hidden. Wide antral pulmonary vein isolation plus a roof line were performed. Patients were followed at 3, 6, 9, and 12 months with clinical visit, ECG, and 48-hour Holter monitoring. The primary endpoint was cumulative radiofrequency (RF) time for all procedures. Atrial arrhythmia >30 seconds after 3 months was a recurrence. Results PeAF was continuous for 26 weeks (interquartile range [IQR] 13–52), and left atrial size was 45 ± 5 mm. Force in the CFS-blinded and CFS-guided arms was 12 g [IQR 6–20] and 14 g [IQR 9–20] (P =.10), respectively. Total RF time did not differ between CFS-guided and CFS-blinded groups (49 ± 14 min vs 50 ± 20 min, respectively; P =.70). Single procedure freedom from atrial arrhythmia was 60% in the CFS-guided arm and 63% in the CFS-blinded arm off drugs. Lesions with gaps were associated with significantly less force (11.4 g [IQR 6–19] vs 13.2 g [IQR 8–20], respectively; P =.0007) and less force-time integral (174 gs [IQR 91–330] vs 210 gs [IQR 113–388], respectively; P <.001). Conclusion CFS-guided ablation resulted in no difference to RF time or 12-month outcome. Lower force/force-time integral was associated with significantly more gaps.

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