Advertisement

The impact of steerable sheaths on unblinded contact force during catheter ablation for atrial fibrillation

  • Marc W. DeyellEmail author
  • Glen Wen
  • Zachary Laksman
  • Matthew T. Bennett
  • Santabhanu Chakrabarti
  • John A. Yeung-Lai-Wah
  • Andrew D. Krahn
  • Jason G. Andrade
Article
  • 20 Downloads

Abstract

Purpose

The purpose of this study was to evaluate the impact of steerable sheaths on multiple contact force parameters during atrial fibrillation (AF) ablation. Steerable sheaths are commonly used during AF ablation, at an additional cost to standard fixed-curve sheaths. However, there is little data on their incremental value in the era of contact force-guided radiofrequency ablation.

Methods

This multi-center cohort study included consecutive patients undergoing index pulmonary vein (PV) isolation with a force-sensing catheter. Operators employed either only steerable or only fixed-curve sheaths. Operators targeted a force of 10–40 g for each ablation lesion. Automated ablation lesion assessment software with standardized settings was employed.

Results

Of 85 subjects, 52 and 33 underwent ablation with steerable and fixed-curve sheaths, respectively. The steerable sheath group showed significantly higher average and maximum forces, but predominantly for the right PVs. The proportion of lesions with ≥ 10% of time with less than 10 g of force was lower in the steerable sheath group (adjusted odds ratio 0.56, steerable vs. fixed; 95% confidence interval 0.35, 0.89, p = 0.01). Improved stability was seen in the posterior aspect of both PV pairs. The proportion of RF time-in-target (the proportion of RF time meeting lesion criteria) was not different between the two groups (p = 0.176).

Conclusions

Even with contemporary contact force targets, steerable sheath use in AF ablation is associated with better average and maximum contact force and increased stability in comparison to fixed-curve sheaths.

Keywords

Atrial fibrillation Catheter ablation Contact force Steerable sheath 

Notes

Acknowledgments

This study was supported through funding from the Division of Cardiology, University of British Columbia. Drs. Deyell, Laksman, and Andrade are recipients of Career Investigator Awards from the Michael Smith Foundation for Health Research (British Columbia, Canada).

We would like to thank Colin Magor, Product Specialist, Biosense-Webster Canada, for his technical support with extraction of the contact force data.

Author contributions

Dr. Deyell was responsible for the study design and concept, data analysis, and interpretation and drafting of the manuscript. Dr. Wen was responsible for the study design, data analysis, and revision of the manuscript. Drs. Bennett, Chakrabarti, Yeung-Lai-Wah, and Krahn were responsible for the study concept and critical revision of the manuscript. Dr. Andrade was responsible for the study design, data interpretation, and critical revision of the manuscript. All authors approved the final version.

Compliance with ethical standards

Conflict of interest

Dr. Deyell has received research funding and honoraria from Biosense-Webster. Dr. Laksman has received research funding from Abbott Medical. Dr. Andrade has received research funding from Medtronic and Baylis Medical.

Ethics approval and informed consent

This study was approved by the human ethics institutional review board at our institutions. Waiver of consent was granted for this study on the basis of minimal risk. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments.

References

  1. 1.
    Karch MR, Zrenner B, Deisenhofer I, Schreieck J, Ndrepepa G, Dong J, et al. Freedom from atrial tachyarrhythmias after catheter ablation of atrial fibrillation: a randomized comparison between 2 current ablation strategies. Circulation. 2005;111(22):2875–80. doi: CIRCULATIONAHA.104.491530.  https://doi.org/10.1161/CIRCULATIONAHA.104.491530.CrossRefGoogle Scholar
  2. 2.
    Oral H, Knight BP, Tada H, Ozaydin M, Chugh A, Hassan S, et al. Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation. 2002;105(9):1077–81.CrossRefGoogle Scholar
  3. 3.
    Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen S-A, et al. HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Heart Rhythm. 2012. 2012;9(4):632–96.e21.  https://doi.org/10.1016/j.hrthm.2011.12.016.CrossRefGoogle Scholar
  4. 4.
    Camm AJ, Lip GYH, De Caterina R, Savelieva I, Atar D, Hohnloser SH, et al. 2012 Focused update of the ESC guidelines for the management of atrial fibrillation. An update of the 2010 ESC guidelines for the management of atrial fibrillation developed with the special contribution of the European Heart Rhythm Association. Eur Heart J. 2012;33(21):2719–47.  https://doi.org/10.1093/eurheartj/ehs253.CrossRefGoogle Scholar
  5. 5.
    Verma A, Macle L, Cox J, Skanes AC. Canadian Cardiovascular Society Atrial Fibrillation Guidelines 2010: catheter ablation for atrial fibrillation/atrial flutter. Can J Cardiol. 2011;27(1):60–6.  https://doi.org/10.1016/j.cjca.2010.11.011.CrossRefGoogle Scholar
  6. 6.
    Piorkowski C, Eitel C, Rolf S, Bode K, Sommer P, Gaspar T, et al. Steerable versus nonsteerable sheath technology in atrial fibrillation ablation: a prospective, randomized study. Circ Arrhythm Electrophysiol. 2011;4(2):157–65.  https://doi.org/10.1161/CIRCEP.110.957761.CrossRefGoogle Scholar
  7. 7.
    Kuck KH, Reddy VY, Schmidt B, Natale A, Neuzil P, Saoudi N, et al. A novel radiofrequency ablation catheter using contact force sensing: Toccata study. Heart Rhythm. 2012;9(1):18–23.  https://doi.org/10.1016/j.hrthm.2011.08.021.CrossRefGoogle Scholar
  8. 8.
    Natale A, Reddy VY, Monir G, Wilber DJ, Lindsay BD, McElderry HT, et al. Paroxysmal AF catheter ablation with a contact force sensing catheter: results of the prospective, multicenter SMART-AF trial. J Am Coll Cardiol. 2014;64(7):647–56.  https://doi.org/10.1016/j.jacc.2014.04.072.CrossRefGoogle Scholar
  9. 9.
    Yokoyama K, Nakagawa H, Shah DC, Lambert H, Leo G, Aeby N, et al. Novel contact force sensor incorporated in irrigated radiofrequency ablation catheter predicts lesion size and incidence of steam pop and thrombus. Circ Arrhythm Electrophysiol. 2008;1(5):354–62.  https://doi.org/10.1161/CIRCEP.108.803650.CrossRefGoogle Scholar
  10. 10.
    Reddy VY, Dukkipati SR, Neuzil P, Natale A, Albenque JP, Kautzner J, et al. Randomized, controlled trial of the safety and effectiveness of a contact force-sensing irrigated catheter for ablation of paroxysmal atrial fibrillation: results of the TactiCath contact force ablation catheter study for atrial fibrillation (TOCCASTAR) study. Circulation. 2015;132(10):907–15.  https://doi.org/10.1161/CIRCULATIONAHA.114.014092.CrossRefGoogle Scholar
  11. 11.
    Masuda M, Fujita M, Iida O, Okamoto S, Ishihara T, Nanto K, et al. Steerable versus non-steerable sheaths during pulmonary vein isolation: impact of left atrial enlargement on the catheter-tissue contact force. J Interv Card Electrophysiol. 2016;47(1):99–107.  https://doi.org/10.1007/s10840-016-0135-4.CrossRefGoogle Scholar
  12. 12.
    Shah DC, Namdar M. Real-time contact force measurement: a key parameter for controlling lesion creation with radiofrequency energy. Circ Arrhythm Electrophysiol. 2015;8(3):713–21.  https://doi.org/10.1161/CIRCEP.115.002779.CrossRefGoogle Scholar
  13. 13.
    Ullah W, Schilling RJ, Wong T. Contact force and atrial fibrillation ablation. J Atr Fibrillation. 2016;8(5):1282.  https://doi.org/10.4022/jafib.1282.Google Scholar
  14. 14.
    Neuzil P, Reddy VY, Kautzner J, Petru J, Wichterle D, Shah D, et al. Electrical reconnection after pulmonary vein isolation is contingent on contact force during initial treatment: results from the EFFICAS I study. Circ Arrhythm Electrophysiol. 2013;6(2):327–33.  https://doi.org/10.1161/CIRCEP.113.000374.CrossRefGoogle Scholar
  15. 15.
    Rajappan K, Baker V, Richmond L, Kistler PM, Thomas G, Redpath C, et al. A randomized trial to compare atrial fibrillation ablation using a steerable vs. a non-steerable sheath. Europace. 2009;11(5):571–5.  https://doi.org/10.1093/europace/eup069.CrossRefGoogle Scholar
  16. 16.
    Kautzner J, Neuzil P, Lambert H, Peichl P, Petru J, Cihak R, et al. EFFICAS II: optimization of catheter contact force improves outcome of pulmonary vein isolation for paroxysmal atrial fibrillation. Europace. 2015;17(8):1229–35.  https://doi.org/10.1093/europace/euv057.CrossRefGoogle Scholar
  17. 17.
    Ullah W, McLean A, Tayebjee MH, Gupta D, Ginks MR, Haywood GA, et al. Randomized trial comparing pulmonary vein isolation using the SmartTouch catheter with or without real-time contact force data. Heart Rhythm. 2016;13(9):1761–7.  https://doi.org/10.1016/j.hrthm.2016.05.011.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Heart Rhythm Services, Division of Cardiology, Department of MedicineUniversity of British ColumbiaVancouverCanada

Personalised recommendations