radiofrequency (RF) ablation, low electrode-tissue contact force (CF) is
associated with ineffective RF lesion formation, whereas excessive CF may
increase the risk of steam pop and perforation. Recently, ablation catheters using two
technologies have been developed to measure real-time catheter-tissue CF. One catheter uses three optical fibers to
measure microdeformation of a deformable body in the catheter tip. The
other catheter uses a small spring connecting the ablation tip electrode to the
catheter shaft with a magnetic transmitter and sensors to measure
microdeflection of the spring.
experimental studies have shown that 1) at constant RF power and application
time, RF lesion size significantly increases with increasing CF; 2) the
incidence of steam pop and thrombus also increase with increasing CF; 3)
modulating RF power based on CF (i.e, high RF power at low CF and lower RF
power at high CF) results in a similar and predictable RF lesion size.
clinical studies in patients undergoing pulmonary vein (PV) isolation, CF
during mapping in the left atrium and PVs showed a wide range of CF and
transient high CF. The most common high
CF site was located at the anterior/rightward left atrial roof, directly
beneath the ascending aorta. There was a
poor relationship between CF and previously used surrogate parameters for CF (unipolar
or bipolar atrial potential amplitude and impedance). Patients who underwent PV isolation with an
average CF of <10 g experienced higher AF recurrence, whereas patients with ablation
using an average CF of > 20g had lower AF recurrence. AF recurred within 12
months in 6 of 8 patients (75%) who had a mean Force-Time Integral (FTI, area
under the curve for contact force vs. time) < 500 gs. In contrast, AF
recurred in only 4 of 13 patients (21%) with ablation using a mean FTI >1000
gs. In another study, controlling RF power based on CF prevented steam pop and
impedance rise without loss of lesion effectiveness.
These studies confirm that CF is a major determinant of
RF lesion size and future systems combining CF, RF power and application time
may provide real-time assessment of lesion formation.
Credits: Hiroshi Nakagawa; Warren M. Jackman