Pacing Mediated Heart Rate Acceleration Improves Catheter Stability and Enhances Markers for Lesion Delivery in Human Atria During Atrial Fibrillation Ablation

Anthony Aizer; Austin V Cheng; Patrick B Wu; Jessica K Qiu; Chirag R Barbhaiya; Steven J Fowler; Scott A Bernstein; David S Park; Douglas S Holmes; Larry A Chinitz

doi:10.1016/j.jacep.2017.12.017

Pacing Mediated Heart Rate Acceleration Improves Catheter Stability and Enhances Markers for Lesion Delivery in Human Atria During Atrial Fibrillation Ablation

JACC Clin Electrophysiol. 2018 Apr;4(4):483-490. doi: 10.1016/j.jacep.2017.12.017. Epub 2018 Mar 1.

Affiliations

¹ New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Medical Center, New York, New York. Electronic address: anthony.aizer@nyumc.org.
² New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Medical Center, New York, New York.

PMID: 30067488
DOI: 10.1016/j.jacep.2017.12.017

Abstract

Objectives: This study sought to investigate the effect of pacing mediated heart rate modulation on catheter-tissue contact and impedance reduction during radiofrequency ablation in human atria during atrial fibrillation (AF) ablation.

Background: In AF ablation, improved catheter-tissue contact enhances lesion quality and acute pulmonary vein isolation rates. Previous studies demonstrate that catheter-tissue contact varies with ventricular contraction. The authors investigated the impact of modulating heart rate on the consistency of catheter-tissue contact and its effect on lesion quality.

Methods: Twenty patients undergoing paroxysmal AF ablation received ablation lesions at 15 pre-specified locations (12 left atria, 3 right atria). Patients were assigned randomly to undergo rapid atrial pacing for either the first half or the second half of each lesion. Contact force and ablation data with and without pacing were compared for each of the 300 ablation lesions.

Results: Compared with lesion delivery without pacing, pacing resulted in reduced contact force variability, as measured by contact force SD, range, maximum, minimum, and time within the pre-specified goal contact force range (p < 0.05). There was no difference in the mean contact force or force-time integral. Reduced contact force variability was associated with a 30% greater decrease in tissue impedance during ablation (p < 0.001).

Conclusions: Pacing induced heart rate acceleration reduces catheter-tissue contact variability, increases the probability of achieving pre-specified catheter-tissue contact endpoints, and enhances impedance reduction during ablation. Modulating heart rate to improve catheter-tissue contact offers a new approach to optimize lesion quality in AF ablation. (The Physiological Effects of Pacing on Catheter Ablation Procedures to Treat Atrial Fibrillation [PEP AF]; NCT02766712).

Keywords: ablation; atrial fibrillation; contact force; lesion quality.

Publication types

Randomized Controlled Trial

MeSH terms

Atrial Fibrillation / surgery*
Cardiac Pacing, Artificial / methods*
Catheter Ablation / methods*
Female
Heart Atria / surgery*
Heart Rate / physiology*
Humans
Male
Middle Aged

Associated data

ClinicalTrials.gov/NCT02766712