Advanced technology for catheter ablation of atrial fibrillation: A double-edged sword?

  • Andrea M. Russo
    Address reprint requests and correspondence: Dr Andrea M. Russo, Director, Electrophysiology and Arrhythmia Services, Cooper Medical School of Rowan University, 3rd Floor Dorrance Building, 1 Cooper Plaza, Camden, NJ 08103.
    Cooper Medical School of Rowan University, Camden, New Jersey
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      Catheter ablation is an important therapeutic modality for the treatment of patients with atrial fibrillation (AF). Although it is a complex procedure that requires specific training, multiple advancements have occurred, including development of new technology to help reduce AF recurrence. Contact force (CF) technology has been recently adopted to enhance lesion formation by helping to ensure tissue contact and adequate lesion depth. Previously, surrogate measures such as a fall in impedance or rise in temperature were used to assess lesion quality, in addition to tactile sensation to help estimate catheter-tissue contact. CF-sensing catheters have been shown to result in a more durable effect of ablation lesions and lower AF recurrence rates (37% reduction during 12-month follow-up).
      • Afzal M.R.
      • Chatta J.
      • Samanta A.
      • Waheed S.
      • Mahmoudi M.
      • Vukas R.
      • Gunda S.
      • Reddy M.
      • Dawn B.
      • Lakkireddy D.
      Use of contact force sensing technology during radiofrequency ablation reduces recurrence of atrial fibrillation: a systematic review and meta-analysis.
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        • Afzal M.R.
        • Chatta J.
        • Samanta A.
        • Waheed S.
        • Mahmoudi M.
        • Vukas R.
        • Gunda S.
        • Reddy M.
        • Dawn B.
        • Lakkireddy D.
        Use of contact force sensing technology during radiofrequency ablation reduces recurrence of atrial fibrillation: a systematic review and meta-analysis.
        Heart Rhythm. 2015; 12: 1990-1996
        • Ghia K.K.
        • Chugh A.
        • Good E.
        • Pelosi F.
        • Jongnarangsin K.
        • Bogun F.
        • Morady F.
        • Oral H.
        A nationwide survey on the prevalence of atrioesophageal fistula after left atrial radiofrequency catheter ablation.
        J Interv Card Electrophysiol. 2009; 24: 33-36
        • Cappato R.
        • Calkins H.
        • Chen S.A.
        • Davies W.
        • Iesaka Y.
        • Kalman J.
        • Kim Y.H.
        • Klein G.
        • Natale A.
        • Packer D.
        • Skanes A.
        Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation.
        J Am Coll Cardiol. 2009; 53: 1798-1803
        • Dagres N.
        • Hindricks G.
        • Kottkamp H.
        • Sommer P.
        • Gaspar T.
        • Bode K.
        • Arya A.
        • Husser D.
        • Rallidis L.S.
        • Kremastinos D.T.
        • Piorkowski C.
        Complications of atrial fibrillation ablation in a high-volume center in 1,000 procedures: still cause for concern?.
        J Cardiovasc Electrophysiol. 2009; 20: 1014-1019
        • Singh S.M.
        • d'Avila A.
        • Singh S.K.
        • Stelzer P.
        • Saad E.B.
        • Skanes A.
        • Aryana A.
        • Chinitz J.S.
        • Kulina R.
        • Miller M.A.
        • Reddy V.Y.
        Clinical outcomes after repair of left atrial esophageal fistulas occurring after atrial fibrillation ablation procedures.
        Heart Rhythm. 2013; 10: 1591-1597
        • Black-Maier E.
        • Pokorney S.D.
        • Barnett A.S.
        • Zeitler E.P.
        • Sun A.Y.
        • Jackson K.P.
        • Bahnson T.D.
        • Daubert J.P.
        • Piccini J.P.
        Risk of atrioesophageal fistula formation with contact-force sensing catheters.
        Heart Rhythm. 2017; 14: 1328-1333
        • Sairaku A.
        • Yoshida Y.
        • Nakano Y.
        • Maeda M.
        • Hirayama H.
        • Hashimoto H.
        • Kihara Y.
        Who is the operator, that is the question: a multicentre study of catheter ablation of atrial fibrillation.
        Europace. 2016; 18: 1352-1356
        • Chavez P.
        • Messerli F.H.
        • Casso Dominguez A.
        • Aziz E.F.
        • Sichrovsky T.
        • Garcia D.
        • Barrett C.D.
        • Danik S.
        Atrioesophageal fistula following ablation procedures for atrial fibrillation: systematic review of case reports.
        Open Heart. 2015; 2: e000257
        • Reddy V.Y.
        • Dukkipati S.R.
        • Neuzil P.
        • 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: 907-915
        • Bhaskaran A.
        • Chik W.
        • Pouliopoulos J.
        • Nalliah C.
        • Qian P.
        • Barry T.
        • Nadri F.
        • Samanta R.
        • Tran Y.
        • Thomas S.
        • Kovoor P.
        • Thiagalingam A.
        Five seconds of 50-60 W radio frequency atrial ablations were transmural and safe: an in vitro mechanistic assessment and force-controlled in vivo validation.
        Europace. 2017; 19: 874-880
        • Singh S.M.
        • d'Avila A.
        • Doshi S.K.
        • Brugge W.R.
        • Bedford R.A.
        • Mela T.
        • Ruskin J.N.
        • Reddy V.Y.
        Esophageal injury and temperature monitoring during atrial fibrillation ablation.
        Circ Arrhythm Electrophysiol. 2008; 1: 162-168
        • Kiuchi K.
        • Okajima K.
        • Shimane A.
        • et al.
        Impact of esophageal temperature monitoring guided atrial fibrillation ablation on preventing asymptomatic excessive transmural injury.
        J Arrhythm. 2016; 32: 36-41
        • Müller P.
        • Dietrich J.W.
        • Halbfass P.
        • Abouarab A.
        • Fochler F.
        • Szöllösi A.
        • Nentwich K.
        • Roos M.
        • Krug J.
        • Schade A.
        • Mügge A.
        • Deneke T.
        Higher incidence of esophageal lesions after ablation of atrial fibrillation related to the use of esophageal temperature probes.
        Heart Rhythm. 2015; 12: 1464-1469

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