The efficacy of catheter ablation of atrial
fibrillation (AF) remains limited. Increase of success would require more
durable lesions without increased risk of steam pop and cardiac perforation. Recently, novel technologies
have been developed to estimate real-time catheter-tissue contact force (CF).
This paper reviews three available tools for assessment of CF and data on
experimental or clinical experience. Experimental data with open-irrigated
catheter showed that lesion size was
greater with applications of lower power (like 30 W) and greater CF (e.g. 30 to
40 g) than vice versa. Impedance drop in
the first 5 seconds was significantly correlated to catheter CF. Perforation
was achieved more rapidly with the ablation catheter in a sheath despite the
same CF because the sheath prevents catheter buckling. Clinical experience confirmed
poor relationship between CF and either unipolar amplitude, bipolar amplitude,
or impedance. Within the left atrium, the most common high CF site was found at
the anterior/rightward LA roof, directly beneath the ascending aorta (confirmed
by merging the CT image and map). Importantly, several studies showed that the
use of CF leads to shorter procedure with less fluoroscopy time and less RF
applications. CF assessment was also found to be associated with higher
proportion of durable lesions. Finally, pilot studies showed that CF
measurement could be associated with better clinical efficacy AF ablation.
Credits: Josef Kautzner; Petr Peichl