Cargando…

Low contact force and force–time integral predict early recovery and dormant conduction revealed by adenosine after pulmonary vein isolation

AIM: After pulmonary vein isolation (PVI), dormant conduction (DC) is present in at least one vein in a substantial number of patients. The present study seeks to determine whether there is a relationship between poor contact forces (CF) and the presence of DC after PVI. METHODS AND RESULTS: This pr...

Descripción completa

Detalles Bibliográficos
Autores principales: le Polain de Waroux, Jean-Benoît, Weerasooriya, Rukshen, Anvardeen, Kalilur, Barbraud, Cynthia, Marchandise, Sebastien, De Meester, Christophe, Goesaert, Cedric, Reis, Ivone, Scavee, Christophe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4447053/
https://www.ncbi.nlm.nih.gov/pubmed/25618742
http://dx.doi.org/10.1093/europace/euu329
_version_ 1782373544409169920
author le Polain de Waroux, Jean-Benoît
Weerasooriya, Rukshen
Anvardeen, Kalilur
Barbraud, Cynthia
Marchandise, Sebastien
De Meester, Christophe
Goesaert, Cedric
Reis, Ivone
Scavee, Christophe
author_facet le Polain de Waroux, Jean-Benoît
Weerasooriya, Rukshen
Anvardeen, Kalilur
Barbraud, Cynthia
Marchandise, Sebastien
De Meester, Christophe
Goesaert, Cedric
Reis, Ivone
Scavee, Christophe
author_sort le Polain de Waroux, Jean-Benoît
collection PubMed
description AIM: After pulmonary vein isolation (PVI), dormant conduction (DC) is present in at least one vein in a substantial number of patients. The present study seeks to determine whether there is a relationship between poor contact forces (CF) and the presence of DC after PVI. METHODS AND RESULTS: This prospective, operator-blinded, non-randomized dual-centre trial enrolled 34 consecutive patients with paroxysmal atrial fibrillation who were candidates for PVI. Radiofrequency (RF) energy was delivered by using an irrigated-tip force-sensing ablation catheter (Tacticath®, St Jude Medical) at pre-defined target power. The operators were blinded to the CF data at all times. A total of 1476 RF applications were delivered in 743 pre-defined PV segments. For each application, the precise location of the catheter was registered and the following data were extracted from the Tacisys® unit: application duration, minimum contact force, maximum contact force, average contact force (CF), and force–time integral (FTI). Sixty minutes after PVI, spontaneous early recovery (ER) of the left atrium (LA) to PV conduction was evaluated. In the absence of ER, the presence of a DC was evaluated by using intravenous adenosine (ATP). In the 34 patients recruited (23 males; mean age: 62 ± 9 years), all PVs were successfully isolated. At the end of the 60 min waiting period, 22 patients demonstrated at least one spontaneous ER or DC under ATP. The mean CF and FTI per PV segment differed significantly among the different veins but the sites of ER and DC were evenly distributed. However, both the minimum, the first and the mean CF and FTI per PV segment were significantly lower in the PV segments presenting either ER or DC as compared with those without ER or DC (mean CF: 4.9 ± 4.8 vs. 12.2 ± 1.65 g and mean FTI: 297 ± 291 vs. 860 ± 81 g s, P < 0.001 for both). Using multivariate analysis, both the mean CF and the FTI per lesion remained significantly associated with the risk of ER or DC. Moreover, a CF < 5 g per PV segment predicted ER+ and DC+ with a sensitivity of 71% and specificity of 82%. In contrast, ER and DC were very unlikely if RF application was performed with a mean CF > 10 g (negative predictive value: 98.7%). CONCLUSION: Both a low CF and a low FTI are associated with the ER of the PVI and DC after PVI.
format Online
Article
Text
id pubmed-4447053
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-44470532015-06-15 Low contact force and force–time integral predict early recovery and dormant conduction revealed by adenosine after pulmonary vein isolation le Polain de Waroux, Jean-Benoît Weerasooriya, Rukshen Anvardeen, Kalilur Barbraud, Cynthia Marchandise, Sebastien De Meester, Christophe Goesaert, Cedric Reis, Ivone Scavee, Christophe Europace Clinical Research AIM: After pulmonary vein isolation (PVI), dormant conduction (DC) is present in at least one vein in a substantial number of patients. The present study seeks to determine whether there is a relationship between poor contact forces (CF) and the presence of DC after PVI. METHODS AND RESULTS: This prospective, operator-blinded, non-randomized dual-centre trial enrolled 34 consecutive patients with paroxysmal atrial fibrillation who were candidates for PVI. Radiofrequency (RF) energy was delivered by using an irrigated-tip force-sensing ablation catheter (Tacticath®, St Jude Medical) at pre-defined target power. The operators were blinded to the CF data at all times. A total of 1476 RF applications were delivered in 743 pre-defined PV segments. For each application, the precise location of the catheter was registered and the following data were extracted from the Tacisys® unit: application duration, minimum contact force, maximum contact force, average contact force (CF), and force–time integral (FTI). Sixty minutes after PVI, spontaneous early recovery (ER) of the left atrium (LA) to PV conduction was evaluated. In the absence of ER, the presence of a DC was evaluated by using intravenous adenosine (ATP). In the 34 patients recruited (23 males; mean age: 62 ± 9 years), all PVs were successfully isolated. At the end of the 60 min waiting period, 22 patients demonstrated at least one spontaneous ER or DC under ATP. The mean CF and FTI per PV segment differed significantly among the different veins but the sites of ER and DC were evenly distributed. However, both the minimum, the first and the mean CF and FTI per PV segment were significantly lower in the PV segments presenting either ER or DC as compared with those without ER or DC (mean CF: 4.9 ± 4.8 vs. 12.2 ± 1.65 g and mean FTI: 297 ± 291 vs. 860 ± 81 g s, P < 0.001 for both). Using multivariate analysis, both the mean CF and the FTI per lesion remained significantly associated with the risk of ER or DC. Moreover, a CF < 5 g per PV segment predicted ER+ and DC+ with a sensitivity of 71% and specificity of 82%. In contrast, ER and DC were very unlikely if RF application was performed with a mean CF > 10 g (negative predictive value: 98.7%). CONCLUSION: Both a low CF and a low FTI are associated with the ER of the PVI and DC after PVI. Oxford University Press 2015-06 2015-01-24 /pmc/articles/PMC4447053/ /pubmed/25618742 http://dx.doi.org/10.1093/europace/euu329 Text en © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Clinical Research
le Polain de Waroux, Jean-Benoît
Weerasooriya, Rukshen
Anvardeen, Kalilur
Barbraud, Cynthia
Marchandise, Sebastien
De Meester, Christophe
Goesaert, Cedric
Reis, Ivone
Scavee, Christophe
Low contact force and force–time integral predict early recovery and dormant conduction revealed by adenosine after pulmonary vein isolation
title Low contact force and force–time integral predict early recovery and dormant conduction revealed by adenosine after pulmonary vein isolation
title_full Low contact force and force–time integral predict early recovery and dormant conduction revealed by adenosine after pulmonary vein isolation
title_fullStr Low contact force and force–time integral predict early recovery and dormant conduction revealed by adenosine after pulmonary vein isolation
title_full_unstemmed Low contact force and force–time integral predict early recovery and dormant conduction revealed by adenosine after pulmonary vein isolation
title_short Low contact force and force–time integral predict early recovery and dormant conduction revealed by adenosine after pulmonary vein isolation
title_sort low contact force and force–time integral predict early recovery and dormant conduction revealed by adenosine after pulmonary vein isolation
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4447053/
https://www.ncbi.nlm.nih.gov/pubmed/25618742
http://dx.doi.org/10.1093/europace/euu329
work_keys_str_mv AT lepolaindewarouxjeanbenoit lowcontactforceandforcetimeintegralpredictearlyrecoveryanddormantconductionrevealedbyadenosineafterpulmonaryveinisolation
AT weerasooriyarukshen lowcontactforceandforcetimeintegralpredictearlyrecoveryanddormantconductionrevealedbyadenosineafterpulmonaryveinisolation
AT anvardeenkalilur lowcontactforceandforcetimeintegralpredictearlyrecoveryanddormantconductionrevealedbyadenosineafterpulmonaryveinisolation
AT barbraudcynthia lowcontactforceandforcetimeintegralpredictearlyrecoveryanddormantconductionrevealedbyadenosineafterpulmonaryveinisolation
AT marchandisesebastien lowcontactforceandforcetimeintegralpredictearlyrecoveryanddormantconductionrevealedbyadenosineafterpulmonaryveinisolation
AT demeesterchristophe lowcontactforceandforcetimeintegralpredictearlyrecoveryanddormantconductionrevealedbyadenosineafterpulmonaryveinisolation
AT goesaertcedric lowcontactforceandforcetimeintegralpredictearlyrecoveryanddormantconductionrevealedbyadenosineafterpulmonaryveinisolation
AT reisivone lowcontactforceandforcetimeintegralpredictearlyrecoveryanddormantconductionrevealedbyadenosineafterpulmonaryveinisolation
AT scaveechristophe lowcontactforceandforcetimeintegralpredictearlyrecoveryanddormantconductionrevealedbyadenosineafterpulmonaryveinisolation