TY - JOUR
T1 - Relationship Between Catheter Stability and 12-Month Success After Pulmonary Vein Isolation
T2 - A Subanalysis of the SMART-AF Trial
AU - Reddy, Vivek Y.
AU - Pollak, Scott
AU - Lindsay, Bruce D.
AU - McElderry, H. Thomas
AU - Natale, Andrea
AU - Kantipudi, Charan
AU - Mansour, Moussa
AU - Melby, Daniel P.
AU - Lakkireddy, Dhanunjaya
AU - Levy, Tzachi
AU - Izraeli, David
AU - Sangli, Chithra
AU - Wilber, David
N1 - Publisher Copyright:
© 2016 American College of Cardiology Foundation
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Objectives This study sought to assess the correlation between catheter and tissue contact force (CF) stability and 12-month clinical success for atrial fibrillation (AF) ablation. Background The SMART-AF (Thermocool Smarttouch Catheter for the Treatment of Symptomatic Paroxysmal Atrial Fibrillation) multicenter trial provided a robust dataset of AF ablation procedures, using the CF sensing ablation catheter. Methods CF and CF stability were correlated with 12-month success for drug-refractory symptomatic AF ablation. CF stability was assessed by stability of ablation parameters (CF, time, location stability) over 3-dimensional electroanatomic maps of pulmonary veins (PVs) using a new proprietary software module and the percentage of time within investigator-selected CF ranges. Available data for potential “PV gaps” were retrospectively identified when stability criteria were not met and were correlated with 12-month success. Results Average CF categories of 0 to 10, 10 to 20, and >20 g were associated with 12-month success rates of 90%, 70%, and 70%, respectively; thus, higher average CF did not correlate with treatment success. An exploratory univariate analysis showed significantly higher success rates with a CF of 6.5 to 10.3 g than with <6.5 g (odds ratio: 2.95; 95% confidence interval: 1.13 to 7.72; p = 0.028) but a CF >10 g did not improve success. When stable CF was applied ≥73% of the time within the preselected CF range, success improved. A receiver operating characteristic curve analysis revealed that PV gaps exceeding 10.6-mm distance significantly correlated with 12-month failure. Conclusions In the SMART-AF trial, CF stability with sufficient CF was most predictive of optimal 12-month success.
AB - Objectives This study sought to assess the correlation between catheter and tissue contact force (CF) stability and 12-month clinical success for atrial fibrillation (AF) ablation. Background The SMART-AF (Thermocool Smarttouch Catheter for the Treatment of Symptomatic Paroxysmal Atrial Fibrillation) multicenter trial provided a robust dataset of AF ablation procedures, using the CF sensing ablation catheter. Methods CF and CF stability were correlated with 12-month success for drug-refractory symptomatic AF ablation. CF stability was assessed by stability of ablation parameters (CF, time, location stability) over 3-dimensional electroanatomic maps of pulmonary veins (PVs) using a new proprietary software module and the percentage of time within investigator-selected CF ranges. Available data for potential “PV gaps” were retrospectively identified when stability criteria were not met and were correlated with 12-month success. Results Average CF categories of 0 to 10, 10 to 20, and >20 g were associated with 12-month success rates of 90%, 70%, and 70%, respectively; thus, higher average CF did not correlate with treatment success. An exploratory univariate analysis showed significantly higher success rates with a CF of 6.5 to 10.3 g than with <6.5 g (odds ratio: 2.95; 95% confidence interval: 1.13 to 7.72; p = 0.028) but a CF >10 g did not improve success. When stable CF was applied ≥73% of the time within the preselected CF range, success improved. A receiver operating characteristic curve analysis revealed that PV gaps exceeding 10.6-mm distance significantly correlated with 12-month failure. Conclusions In the SMART-AF trial, CF stability with sufficient CF was most predictive of optimal 12-month success.
KW - catheter stability parameters
KW - contact force
KW - paroxysmal atrial fibrillation
KW - pulmonary vein isolation
KW - radiofrequency catheter ablation
UR - http://www.scopus.com/inward/record.url?scp=84996761536&partnerID=8YFLogxK
U2 - 10.1016/j.jacep.2016.07.014
DO - 10.1016/j.jacep.2016.07.014
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AN - SCOPUS:84996761536
SN - 2405-500X
VL - 2
SP - 691
EP - 699
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 6
ER -