Relationship Between Catheter Stability and 12-Month Success After Pulmonary Vein Isolation: A Subanalysis of the SMART-AF Trial

Vivek Y. Reddy, Scott Pollak, Bruce D. Lindsay, H. Thomas McElderry, Andrea Natale, Charan Kantipudi, Moussa Mansour, Daniel P. Melby, Dhanunjaya Lakkireddy, Tzachi Levy, David Izraeli, Chithra Sangli, David Wilber

Research output: Contribution to journalArticlepeer-review

52 Scopus citations

Abstract

Objectives This study sought to assess the correlation between catheter and tissue contact force (CF) stability and 12-month clinical success for atrial fibrillation (AF) ablation. Background The SMART-AF (Thermocool Smarttouch Catheter for the Treatment of Symptomatic Paroxysmal Atrial Fibrillation) multicenter trial provided a robust dataset of AF ablation procedures, using the CF sensing ablation catheter. Methods CF and CF stability were correlated with 12-month success for drug-refractory symptomatic AF ablation. CF stability was assessed by stability of ablation parameters (CF, time, location stability) over 3-dimensional electroanatomic maps of pulmonary veins (PVs) using a new proprietary software module and the percentage of time within investigator-selected CF ranges. Available data for potential “PV gaps” were retrospectively identified when stability criteria were not met and were correlated with 12-month success. Results Average CF categories of 0 to 10, 10 to 20, and >20 g were associated with 12-month success rates of 90%, 70%, and 70%, respectively; thus, higher average CF did not correlate with treatment success. An exploratory univariate analysis showed significantly higher success rates with a CF of 6.5 to 10.3 g than with <6.5 g (odds ratio: 2.95; 95% confidence interval: 1.13 to 7.72; p = 0.028) but a CF >10 g did not improve success. When stable CF was applied ≥73% of the time within the preselected CF range, success improved. A receiver operating characteristic curve analysis revealed that PV gaps exceeding 10.6-mm distance significantly correlated with 12-month failure. Conclusions In the SMART-AF trial, CF stability with sufficient CF was most predictive of optimal 12-month success.

Original languageEnglish
Pages (from-to)691-699
Number of pages9
JournalJACC: Clinical Electrophysiology
Volume2
Issue number6
DOIs
StatePublished - 1 Nov 2016

Keywords

  • catheter stability parameters
  • contact force
  • paroxysmal atrial fibrillation
  • pulmonary vein isolation
  • radiofrequency catheter ablation

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