Utilization of an Advanced Ablation Lesion Annotation System with Force Sensing Catheters Dramatically Reduces Adenosine Induced Pulmonary Vein Reconnection Following Radiofrequency Ablation for Atrial fibrillation

Guy Rozen1, Kevin Heist1, Moshe Rav Acha2, Leon Ptaszek1, Kevin Heist, Jeremy Ruskin1, Moussa Mansour1
1 Heart Center, Massachusetts General Hospital, USA
2 Heart Center, Shaare Zedek Medical Center, Israel

Aim: The ability to achieve transmural, durable lesions is a significant challenge of a pulmonary vein isolation (PVI) procedure resulting in their reconnection. We aim to assess the effect of PVI ablation utilizing a force-sense irrigated tip catheter in conjunction with a novel automated ablation lesions annotation system, on Adenosine induced pulmonary veins re-connection.

Methods and Results: We prospectively studied consecutive patients undergoing PVI ablation, utilizing an automatic point acquisition module of the CARTO 3 system (VISITAG Module, Biosense Webster Inc.) and a force sensing catheter. The module automatically annotated only ablation lesions that met predefined parameters of: (1) catheter stability range of motion ≤2 mm, (2) catheter stability duration of ≥10 seconds, (3) force-time integral of ≥300g*sec. Adenosine induced PV re-connection rate was compared with a control group of consecutive patients who underwent PVI in a “conventional setting” with an irrigated tip ablation catheter, CARTO 3 system and manual ablation points acquisition. All the ablations were performed using an identical ablation setting and technique.

Study population included 42 patients in the study and 39 patients in the control group, all undergoing first PVI, with no structural heart disease on echocardiography. There was no significant difference in atients’ baseline demographic and clinical characteristics. The average age was 64.1±7.8 years and 59.6±11.4 years, with 33 (78.6%) and 29 (74.4%) males in the study and control group, respectively. The rate of persistent AF was similar (42% vs. 46%) between the two groups, as the average duration since the initial AF diagnosis (3.6 years vs. 4.1 years). The PV reconnection rate was found to be 9.5% vs. 28.2% (p=0.029) for study and control groups, respectively. The study group was the only parameter found to predict PV reconnection.

Conclusion: The utilization of a force sensing, irrigated-tip catheter in conjunction with a novel automated ablation lesions annotation system (VISITAG module), dramatically reduces the acute pulmonary veins reconnection rate when compared with a “conventional” PVI setting.