Use of electrical coupling information in AF catheter ablation: a prospective randomized pilot study.

Heart rhythm : the official journal of the Heart Rhythm Society

PubMedID: 23059130

Gaspar T, Sih H, Hindricks G, Eitel C, Sommer P, Kircher S, Rolf S, Arya A, Teplitsky L, Piorkowski C. Use of electrical coupling information in AF catheter ablation: a prospective randomized pilot study. Heart Rhythm. 2013;10(2):176-81.
BACKGROUND
Catheter contact is important for radiofrequency (RF) ablation. Local electrical catheter-to-tissue coupling has been described as a tool to objectively measure contact.

OBJECTIVE
We hypothesized that pulmonary vein isolation (PVI) ablation using electrical coupling information (ECI) would yield higher rates of PVI than an approach without ECI.

METHODS
Forty patients with atrial fibrillation were prospectively included. In each patient, 1 pair of pulmonary veins (PVs) was randomly chosen to be encircled with ECI available while the other pair was encircled without use of ECI.

RESULTS
The rate of PVI was significantly higher in PVs encircled with ECI available (58% vs 30%; P = .024). PV encircling with coupling resulted in slightly longer procedure (26.5 [interquartile range {IQR} 22-32.5] vs 23.5 [IQR 19-26.5] minutes; P = .019), fluoroscopy (9.0 [IQR 6-12] vs 6.9 [IQR 4-8.6] minutes; P = .011), and RF (20.0 [IQR 16.5-23.5] vs 17.3 [IQR 15.1-20.6] minutes; P = .015) times. For nonisolated PVs, the coupling group had significantly fewer gaps (3.0 [IQR 1.8-7] vs 6.0 [IQR 4-11]; P = 0.021) and gap mapping/closure needed shorter procedure (9.0 [IQR 4-16] vs 13.0 [IQR 11-21] minutes; P = .04), fluoroscopy (3.9 [IQR 2-7.1] vs 6.0 [IQR 4.6-7.9] minutes; P = .038), and RF (1.9 [IQR 0.9-5] vs 5.2 [IQR 3.3-8.6] minutes; P = .016) times.

CONCLUSIONS
The use of ECI improved lesion deployment measured as higher rates of PVI after anatomical encircling. For nonisolated PVs, fewer gaps and faster gap closure were found using ECI.