Feasibility and safety of high-power ablation of atrial fibrillation with contact force-sensing catheter: The lesion size index-guided ablation

Background: Radiofrequency (RF) ablation is a commonly used method of atrial fibrillation (AF) treatment. High-power short-duration (HPSD) ablation has been suggested as a method to reduce procedure times whilst creating safe and lasting lesions. High-power ablation with contact force (CF)-sensing technology catheters might aid in a further improvement of safety whilst generating lasting transmural lesions.

Objectives: We report our experience using lesion size index (LSI)-guided 50 W ablation with a CF-sensing catheter of AF.

Material and methods: We performed LSI-guided 50 W point-by-point ablation using a CF-sensing catheter (TactiCath). Target LSI at the anterior left atrium (LA) was 5.0 and at the posterior LA it was 4.5.

Results: Altogether, 4641 RF lesions were created in 86 consecutive patients. To reach a mean LSI of 4.9 ±0.01, a mean RF ablation time of 14.3 ±0.1 s was applied with a mean CF of 13.4 ±0.1 g. The RF time per lesion at the anterior wall of LA was 15.9 ±0.2 s, while it was 13 ±0.2 s at the posterior wall of LA. We observed force time integral (FTI) values between 36 g and 310 g. Procedure duration was 107 ±4 min with a RF ablation time of 15.4 ±0.6 min. No audible steam pops occurred. No pericardial effusion was observed. After a 1-year follow-up, no adverse events were reported and 83% of patients had no symptomatic arrhythmia recurrence.

Conclusions: We provide evidence for the safety and efficacy of LSI-guided 50 W ablation using the TactiCath CF-sensing ablation catheter. These data support the use of high-power ablation with CF sensing technology to improve both safety and efficacy.