Contact Force Catheters in VT ablation

The results are surprising. I would have expected CF catheters to be safer and better but no, not for VT ablation anyway at a top center in Europe. Left ventricle heart wall thickness is around 11 mm +/- 2mm. Atrium wall thickness is anywhere from 0.5 mm to 3.5 mm averaging less than 2mm. So I am not sure if the results mean anything for AF ablation. LVT ablation is more complex than AF ablation because of more difficult access and relatively large motions of several mm's during the pumping cycle plus the patients typically have heart failure with low ejection fraction. Authors did the study with the expectation that CF catheters improves results. Abstract is below. Paper accepted for publication in JCEP last week. Study was done at Thoraxcenter, Netherlands.
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Original
Safety and clinical outcome of catheter ablation of ventricular arrhythmias using contact force sensing: Consecutive case series

A.A. Hendriks MD1,2, F. Akca1, L. Dabiri Abkenari MD PhD1, M. Khan MD2, R. Bhagwandien MD1, S.C. Yap MD PhD1, S. Wijchers MD1 andTamas Szili-Torok MD PhD1,*
DOI: 10.1111/jce.12762

Background
: Poor catheter-to-myocardial contact can lead to ineffective ablation lesions and suboptimal outcome. Contact force (CF) sensing catheters in ventricular tachyarrhythmia (VT) ablations has not been studied for their long-term efficacy.

Purpose
: The aim of this study was to compare CF ablation to manual ablation (MAN) and remote magnetic navigation (RMN) ablation for safety and efficacy in acute and long-term outcome.

Methods
: A total of 239 consecutive patients who underwent VT ablation with the use of MAN, CF or RMN catheters were included in this single-center cohort study from January 2007 until March 2014. The primary endpoints were procedural success, acute major complications and VT recurrences at follow-up. The median follow-up period was 25 months.

Results
: Acute success was achieved in 182 out of 239 procedures (76%). Acute success in manual ablation, CF ablation and RMN ablation was 71%, 71% and 86%, respectively (P = 0.03). Major complications occurred in 3.3% and there were less major complications (P = 0.04) in the RMN group. After an initial successful procedure, 66 of 182 patients (36%) patients had a recurrence during follow-up. This was not significantly different between groups. Using an intention-to-treat analysis, 124 patients (52%) had a recurrence. The recurrence rate was lowest in the RMN group.

Conclusion
: The use of CF sensing catheters did not improve procedural outcome or safety profile in comparison to non-CF sensing ablation in this observational study of ventricular arrhythmia ablations.



Edited 3 time(s). Last edit at 08/11/2015 03:33PM by researcher.

It is hard to tell from the abstract what happened in terms of complications so here is a detailed breakdown from Table 3 (sorry couldn't cut and paste, I have paper copy).

Major complications differ significantly between CF, MAN and RMN. Respectively, they are 10%, 2.7% and 1.2%.
Major acute complications are 2.4%, 0% and 0% respectively.
Major catheter ablation related are 2.4%, 1.8% and 1.2% respectively.
Major vascular access related are 4.9%, 0.9% and 1.2%. respectively.
Minor complications are 9.6%, 8.9% and 4.7% respectively.
Overall major plus minor complications are 19%, 12% and 5.8% respectively

Fellows from same group had earlier published a study of their single center experience in SVT, AF and VT ablations. When analysed by the AF subgroup, CF catheters were safer in fellow hands. I imagine the fellows were mostly observing the higher complexity VT procedures. Link below -

[www.ncbi.nlm.nih.gov]

AF results from a group of high volume centers shows statistical significant advantages for CF catheter over non-CF catheters, see link below. In summary, VT comparison results do not apply to AF as far as CF catheters are concerned probably because of more demanding navigational flexibility.

[www.ncbi.nlm.nih.gov]