Multicentre randomised trial comparing contact force with electrical coupling index in atrial flutter ablation...

Area of Science:

• Electrophysiology
• Cardiovascular Medicine
• Medical Devices

Background:

• Catheter ablation is a key treatment for atrial flutter (AFL).
• Electrical Coupling Index (ECI) and Contact Force (CF) are emerging tools to optimize lesion formation during ablation procedures.
• Assessing catheter-tissue interaction is crucial for effective ablation outcomes.

Purpose of the Study:

• To evaluate if catheter-tissue interaction data, specifically ECI and CF, can reduce the time required to achieve bidirectional cavotricuspid isthmus block during AFL ablation.
• To determine the impact of real-time ECI and CF visualization on procedural efficiency and efficacy.

Main Methods:

• A randomized study involving 114 patients with AFL undergoing catheter ablation.
• Patients were assigned to groups with visible or non-visible ECI and CF data.
• The primary endpoint was the time to achieve bidirectional cavotricuspid isthmus block, with follow-up at 3 and 6 months.

Main Results:

• Visible ECI significantly shortened the time to bidirectional block (median 10.5 mins vs. 30.0 mins, p=0.023).
• Visible CF demonstrated a trend towards reduced block time and was associated with higher applied force.
• No significant differences were observed in acute recurrence, complication rates, or long-term AFL recurrence.

Conclusions:

• Real-time visualization of ECI during AFL ablation is associated with a significantly reduced time to achieve bidirectional block.
• Contact force data enhances catheter contact and shows a trend toward procedural endpoint improvement.
• These findings support the integration of tissue contact information in guiding catheter ablation procedures.