Contact-force recovery predicts the absence of cardiac perforation during steam pops

Cardiac perforation (CP) is an uncommon but clinically important complication of radiofrequency ablation (RFA). We previously showed that contact-force recovery after a steam pop predicts the absence of CP in an open-chest animal model after pericardial dissection. We attempted to determine whether this also applies when pericardium is present.

In 5 open-chest sheep, left atrial RFA was performed under direct observation with a 7.5F ThermoCool SmartTouch force-sensing catheter (Biosense Webster Inc., Irvine, CA, USA). The catheter's contact force was measured every 50 ms during RFA. After each steam pop, the presence (+) or absence (-) of CP was noted, as well as whether pericardium was present over the ablation site. Contact-force signals were analyzed to detect contact-force recovery. Perforation rates were compared between sites with or without pericardium.

Ninety-six steam pops occurred: 77 with pericardium and 19 without. For the pericardial steam pops, contact-force recovery occurred in 31/60 CP- events (52%) and 1/17 CP+ events (6%; P = 0.0006). For nonpericardial steam pops, contact-force recovery occurred in 4/9 CP- events (44%) and 1/10 CP+ events (P = 0.14). The rate of CP was 22% with pericardium and 52% without (P = 0.02). Pericardial tissue charred extensively during steam pop induction, even in the absence of CP.

Contact-force recovery predicts the absence of CP during RFA independently of whether the pericardium is present. The presence of the pericardium may decrease the likelihood of perforation, perhaps by acting as a thermal sink. Additional studies are needed to correlate these results with clinical experience.