5 years ago

Contact force Sensing for Ablation of Persistent Atrial Fibrillation: A Randomized, Multicenter Trial

Impact of contact force sensing (CFS) on ablation of persistent atrial fibrillation (PeAF) is unknown. Objective The TOUCH AF randomized trial compared CFS guided ablation to a CFS blinded strategy. Methods Patients (n=128) undergoing first-time ablation for persistent AF were randomized to a CFS guided vs CFS blinded strategy. In the CFS guided procedure, operators visualized real-time force data; in the blinded procedure, force data was hidden. Wide antral pulmonary vein isolation plus a roof-line were performed. Patients were followed at 3, 6, 9, and 12 months with visit, ECG, & 48-hr Holter. The primary endpoint was cumulative radiofrequency (RF) time for all procedures. Atrial arrhythmia >30 seconds after 3 months was a recurrence. Results PeAF was continuous for 26 weeks (IQR 13-52) and left atrial size was 45±5 mm. Force in the CFS blinded and guided arms were 12 [IQR 6-20] and 14 [IQR 9-20] g (p=0.10). Total RF time did not differ between CFS guided and blinded groups (49 ± 14 min vs 50 ± 20 min, p=0.70). Single procedure freedom from atrial arrhythmia was 60% in the CFS guided arm and 63% in the CFS blinded off drugs. Lesions with gaps were associated with significantly less force (11.4 [IQR 6-19] vs 13.2 [IQR 8-20] g, p=0.0007) and less force time integral (174 [IQR 91-330] vs 210 [IQR 113-388] gs, p<0.001). Conclusions CFS guided ablation resulted in no difference to RF time or 12 month outcome. Lower force/FTI was associated with significantly more gaps.

Publisher URL: www.sciencedirect.com/science

DOI: S1547527117312031

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