Contact Force Sensing vs Natale

Evidently nothing can beat Natale's magical hands; not robotics or sensing catheters. Bulkier and harder to maneuver into tight areas too I read.
I had no reconnections of my index PVI prior to my second ablation after 30 months with the Meastro at St David's March 1 as is the case with most of his patients.
He did tell me at St Lukes after my 30 day followup he just hasn't seen much in 6 years.

[www.medscape.com]

SmartTouch Contact-Force Sensing Data Fail to Fire in Atrial-Fibrillation Ablation
Patrice Wendling
May 13, 2016

Can't anybody make a durable PVI after all these years

[www.medscape.com]

McHale



Edited 4 time(s). Last edit at 05/15/2016 04:10AM by McHale.

The Contact Force (CF) catheters have a learning curve too and are a bit stiffer and more prone to cause tissue injury if care is not taken to avoid too much CF combine with too much time on tissue and/or too much power.

At HRS Doug Packer and Andrea Natale both emphasized not to use more that 10-20 grams of CF with 10 to 15 grams being typically optimal CF paired with a range of 30 to 45 watts depending on the tissue thickness and area being ablated. This ratio of CF range and power ranges is typically the best combination to achieve high degree of transmural
Lesions created without complications.

But too many have not got the message yet and Doug Packer who is head of Mayo Clinics big AFIB program said he now knows of 31 plus patient who had suffered the dreaded esophageal fistula via CF catheters.

Using FTI (force/time interval) and AI (ablation index) in which power levels are accounted for too are the best ways to avoid problems with CF catheters.

The St Jude Tacticath CF catheter with its laser guided force sensing mechanism has been shown now to be superior to the SmartTouch catheter with its mechanical spring force sensing design.

Shannon



Edited 1 time(s). Last edit at 05/15/2016 11:20PM by Shannon.

The same British group has a very interesting and detailed CF review article in the current issue of Journal of AF that goes over data. CF has increased EP's understanding of sufficient tissue contact, both too much and the lack of. Between 10 grams and 20 grams, lesion size is the same. Above 30 grams, care is needed on RF power to avoid steam pops and perforation.

That's exactly right researcher, and just what was discussed at the CME dinner at HRS in San Fran last week where a handful of renowned EPs like Packer, Marchlinski, David Callans and Natale gave case study presentations and proper CF tips and warnings were plentiful.

Docs that run the CF up to 30 grams are asking for trouble and that 10 to 20 grams with 15grams being the overall best in most areas of the atria allow the EP to titrate power from 30 up to 45 Watts as needed for thinner or thicker tissue or muscle ridges etc and get good transmural lesions without much risk of tamponade or steam pops.

CF can be done quite safely, but like anything new it takes climbing the learning curve and knowing the ropes.

Shannon



Edited 2 time(s). Last edit at 05/18/2016 12:18AM by Shannon.