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Gains in Paroxysmal Atrial Fibrillation Ablation Using a Standardized Workflow to Optimize Contact Force Technologies

Background Catheter ablation technology has evolved rapidly in recent years. There is a need to understand the impact of these advances on efficiency, safety, and efficacy in real-world populations. The objective of this study was to evaluate a standardized workflow that integrates a contact force (CF) catheter and stability module in an attempt to optimize efficiency and clinical outcomes of paroxysmal atrial fibrillation (PAF) ablation, and to compare the outcomes of this workflow with existing ablation technologies at a high-volume center. Methods Consecutive ablations for PAF from July 2013 - June 2016 were included. Radiofrequency (RF) ablations were performed with the Thermocool SF Catheter (SF) through April 2014, at which time a change was made to the Thermocool Smarttouch Catheter (ST) with a standardized workflow. Cryoballoon ablations (CA) were performed with the Arctic Front Advance between July 2013 and March 2016. Systematic 12-month effectiveness data collection has been captured since July 2014, with only acute outcomes and reablations captured previously. Results Procedural data for 32 SF, 232 ST, and 59 CA procedures for PAF were available. Mean procedure times were similar across SF and CA, and moderately shorter with ST (p=0.0201). Fluoroscopy times were substantially reduced with ST (p<0.0001). Complication rates were low and similar across all cohorts (p=0.4744), whereas reablation rates were lowest in the ST cohort (p=0.0194). Conclusion PAF ablation using integrated CF and catheter stability technology with a systematic ablation workflow can lead to improvements in both procedural efficiency and reablation rates, without compromising patient safety.

Credits: Jose Osorio, MD; Tina D Hunter, PhD; Rosemary S Bubien, RN, MSN; Anil Rajendra, MD; Joaquin Arciniegas, MD; Gustavo Morales, MD

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