Optimal Force–Time Integral for Pulmonary Vein Isolation According to Anatomical Wall Thickness Under the Ablation Line

• Published in: Journal of the American Heart Association 2016-03, Vol.5 (3), p.e003155-n/a
• Main Authors: Chikata, Akio, Kato, Takeshi, Sakagami, Satoru, Kato, Chieko, Saeki, Takahiro, Kawai, Keiichi, Takashima, Shin‐ichiro, Murai, Hisayoshi, Usui, Soichiro, Furusho, Hiroshi, Kaneko, Shuichi, Takamura, Masayuki
• Format: Article
• Language: English
• Subjects: Action Potentials; Adult; Aged; Aged, 80 and over; Area Under Curve; atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; atrial wall thickness; Catheter Ablation - adverse effects; Catheter Ablation - methods; contact force; Echocardiography, Three-Dimensional; Electrophysiologic Techniques, Cardiac; Female; force–time integral; Heart Atria - diagnostic imaging; Heart Atria - physiopathology; Heart Atria - surgery; Heart Rate; Humans; Male; Middle Aged; Multidetector Computed Tomography; Multimodal Imaging - methods; Original Research; Predictive Value of Tests; pulmonary vein isolation; Pulmonary Veins - diagnostic imaging; Pulmonary Veins - physiopathology; Pulmonary Veins - surgery; Retrospective Studies; ROC Curve; Time Factors; Treatment Outcome
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.115.003155

Background Low contact force and force–time integral (FTI) during catheter ablation are associated with ineffective lesion formation, whereas excessively high contact force and FTI may increase the risk of complications. We sought to evaluate the optimal FTI for pulmonary vein (PV) isolation based on atrial wall thickness under the ablation line. Methods and Results Contact force parameters and FTI during anatomical ipsilateral PV isolation for atrial fibrillation and atrial wall thickness were assessed retrospectively in 59 consecutive patients for their first PV isolation procedure. The PV antrum was divided into 8 segments, and the wall thickness of each segment under the ablation line was determined using multidetector computed tomography. The FTI for each ablation point was divided by the wall thickness of the PV antrum segment where each point was located to obtain FTI/wall thickness. In total, 5335 radiofrequency applications were delivered, and 85 gaps in PV isolation ablation lines and 15 dormant conductions induced by adenosine were detected. The gaps or dormant conductions were significantly associated with low contact force, radiofrequency duration, FTI, and FTI/wall thickness. Among them, FTI/wall thickness had the best prediction value for gaps or dormant conductions by receiver operating characteristic curve analysis. FTI/wall thickness of