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Effect of Respiration on Catheter-Tissue Contact Force During Ablation of Atrial Arrhythmias.
MedLine Citation:
PMID:  22342855     Owner:  NLM     Status:  Publisher    
BACKGROUND:: Catheter-tissue contact is important for effective lesion creation. OBJECTIVE:: We assessed the effect of respiration on contact force (CF) during atrial fibrillation (AF) and cavo-tricuspid isthmus (CTI) dependent atrial flutter (AFL) ablation. METHODS:: Patients with undergoing CTI ablation alone (n=15) and pulmonary vein isolation alone (n=12) under general anesthesia were recruited. Lesions were delivered under ventilation (30s) alternating with lesions delivered under apnea (30s) at an adjacent anatomical site at CTI or PV antra. Average force (F(av)), force-time integral (FTI), force variability index (F(var)) were measured in a region specific manner using a novel CF-sensing ablation catheter. Operators were blinded to CF data. RESULTS:: F(av) and FTI were higher with apnea compared to ventilation in all CTI and PV segments ( P < .05), an effect attributed to drop in CF with each respiratory swing, resulting in greater F(var) during ventilation ( P < .05). Low FTI lesions (<500g) were strongly associated with longer ablation time to achieve bi-directional CTI block (r(2)=0.81, P < .001), left (r(2)=0.65, P = .009) and right PVI (r(2)=0.41, P = .05). Sites with transient CTI block were associated with lower F(av) and FTI than sites with persistent CTI block ( P < .05). Sites of acute PV reconnection were associated with lower F(av) and FTI compared to non-reconnected sites ( P < .001). CONCLUSIONS:: Catheter-tissue CF is critically influenced by respiration; greater CF is observed with ablation during apnea. Poor CF is implicated in longer ablation time to achieve CTI block or PVI and in acute reconnection.
Saurabh Kumar; Joseph B Morton; Karen Halloran; Steven J Spence; Geoffrey Lee; Michael C G Wong; Peter M Kistler; Jonathan M Kalman
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-2-14
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  -     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-2-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012. Published by Elsevier Inc.
Department of Cardiology, The Royal Melbourne Hospital, Parkville, Australia; Department of Medicine, University of Melbourne, Parkville, Australia; Department of Cardiology, Alfred Hospital and Baker IDI, Prahran, Australia.
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