The Effect of Contact Force in Atrial Radiofrequency Ablation Electroanatomical, Cardiovascular Magnetic Resonance, and Histological Assessment in a Chronic Porcine Model

Steven E. Williams*, James Harrison, Henry Chubb, Lars Ølgaard Bloch, Niels Peter Andersen, Høgni Dam, Rashed Karim, John Whitaker, Jaswinder Gill, Michael Cooklin, C. Aldo Rinaldi, Kawal Rhode, Matthew Wright, Tobias Schaeffter, Won Yong Kim, Henrik Jensen, Reza Razavi, Mark D. O'Neill

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

39 Citations (Scopus)

Abstract

Objectives This study sought to determine the effect of contact force (CF) on atrial lesion size, quality, and transmurality by using a chronic porcine model of radiofrequency ablation. Background CF is a major determinant of ventricular lesion formation, but uncertainty exists regarding the most appropriate CF parameters to safely achieve permanent, transmural lesions in the atria. Methods Intercaval linear ablation (30 W, 42°C, 17 ml/min irrigation) was performed in 8 Göttingen minipigs by using a force-sensing catheter with CF >20 g (high force) or <10 g (low force) at alternate ends of the line, separated by an intentional gap. Voltage mapping and cardiovascular magnetic resonance (CMR) imaging were performed pre-ablation, immediately after ablation, and at 2 months' post-procedure. Lesions were sectioned orthogonal to the axis of ablation to assess transmurality. Results Mean CF was 22.6 ± 11.4 g and 7.8 ± 4.0 g in the high and low CF regions. Acute tissue edema was greater with high CF, both caudally (7.0 mm vs. 4.6 mm; p = 0.016) and cranially (6.9 mm vs. 4.6 mm; p = 0.038). There was no difference in chronic lesion size (voltage mapping) or volume (late gadolinium enhancement CMR) between high and low CF regions. There was no difference in scar density (assessed by low-voltage criteria and late gadolinium enhancement signal intensity) or histological transmurality between high and low CF regions. Conclusions Although high CF (>20 g) resulted in more acute tissue edema than low CF (<10 g), chronically there was no difference in lesion size, quality, or transmurality. Appropriate CF targets for atrial ablation may be lower than previously thought.

Original languageEnglish
Pages (from-to)421-431
Number of pages11
JournalJACC: Clinical Electrophysiology
Volume1
Issue number5
Early online date20 Aug 2015
DOIs
Publication statusPublished - 1 Oct 2015

Keywords

  • atrial fibrillation
  • cardiovascular magnetic resonance
  • contact force
  • radiofrequency ablation

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