Paroxysmal AF Catheter Ablation With a Contact Force Sensing Catheter

• Published in: Journal of the American College of Cardiology 2014-08, Vol.64 (7), p.647-656
• Main Authors: Natale, Andrea, MD, Reddy, Vivek Y., MD, Monir, George, MD, Wilber, David J., MD, Lindsay, Bruce D., MD, McElderry, H. Thomas, MD, Kantipudi, Charan, MD, Mansour, Moussa C., MD, Melby, Daniel P., MD, Packer, Douglas L., MD, Nakagawa, Hiroshi, MD, Zhang, Baohui, MS, SM, Stagg, Robert B., PhD, Boo, Lee Ming, PharmD, Marchlinski, Francis E., MD
• Format: Article
• Language: English
• Subjects: Cardiac arrhythmia; Cardiology; Cardiovascular; Catheters; Confidence intervals; Electrodes; Internal Medicine; Patients; Quality of life; Studies
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2014.04.072

Abstract Background Catheter ablation is important for treatment of paroxysmal atrial fibrillation (PAF). Limited animal and human studies suggest a correlation between electrode-tissue contact and radiofrequency lesion generation. Objectives The study sought to assess the safety and effectiveness of an irrigated, contact force (CF)-sensing catheter in the treatment of drug refractory symptomatic PAF. Methods A prospective, multicenter, nonrandomized study was conducted. Enrollment criteria included: ≥3 symptomatic episodes of PAF within 6 months of enrollment and failure of ≥1 antiarrhythmic drug (Class I to IV). Ablation included pulmonary vein isolation with confirmed entrance block as procedural endpoint. Results A total of 172 patients were enrolled at 21 sites, where 161 patients had a study catheter inserted and 160 patients underwent radiofrequency application. Procedural-related serious adverse events occurring within 7 days of the procedure included tamponade (n = 4), pericarditis (n = 3), heart block (n = 1, prior to radiofrequency application), and vascular access complications (n = 4). By Kaplan-Meier analyses, 12-month freedom from atrial fibrillation/atrial flutter/atrial tachycardia recurrence was 72.5%. The average CF per procedure was 17.9 ± 9.4 g. When the CF employed was between investigator selected working ranges ≥80% of the time during therapy, outcomes were 4.25 times more likely to be successful (p = 0.0054; 95% confidence interval: 1.53 to 11.79). Conclusions The SMART-AF trial demonstrated that this irrigated CF-sensing catheter is safe and effective for the treatment of drug refractory symptomatic PAF, with no unanticipated device-related adverse events. The increased percent of time within investigator-targeted CF ranges correlates with increased freedom from arrhythmia recurrence. Stable CF during radiofrequency application increases the likelihood of 12-month success. (THERMOCOOL® SMARTTOUCH® Catheter for Treatment of Symptomatic Paroxysmal Atrial Fibrillation; NCT01385202 )