Persistent Atrial Fibrillation Ablation With or Without Contact Force Sensing

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Catheter‐based ablation targeting isolation of the pulmonary veins (PVs) has become an effective treatment strategy for paroxysmal atrial fibrillation (AF).1 However, in patients with persistent AF (PersAF), arrhythmia recurrences are still common,1 despite intensive clinical and research efforts over the past 2 decades.
A challenging, yet critical, aspect of AF ablation is to maintain a good catheter‐tissue contact to create ablation lesions. Catheter‐tissue contact force (CF) has been recognized as an important determinant of radiofrequency (RF) ablation lesion size and quality.7 RF ablation quality is perhaps more impactful in PersAF, due to critical interaction of triggers and substrate that results in persistence of the arrhythmia and predispose to recurrences after ablation. Traditionally, contact during RF applications has been judged by tactile feedback, intraprocedural imaging, and changes in intracardiac electrograms and impedance. A more objective assessment of catheter‐tissue CF has become possible with the recent introduction of CF‐sensing catheters that directly measure the catheter tip to tissue CF.10
To date, most of the published outcome data with CF sensing have been in paroxysmal AF ablation.11 Meta‐analyses of published reports21 showed the reduction in both arrhythmia recurrence rates and radiation exposure with the use of CF sensing versus conventional ablation catheters. A recently published clinical trial showed that in paroxysmal AF ablation, CF sensing was associated with reduced acute PV reconnection but not improved 1‐year success rates.23
In PersAF, it has been suggested that nonrobotic ablation with CF sensing was not associated with improved outcomes compared to traditional catheters.13 We sought to assess the safety, procedural profiles, and outcomes of PersAF ablation with and without use of CF‐sensing ablation catheters.
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