Superior efficacy of pulmonary vein isolation with online contact force measurement persists after the learning period: a prospective case control study.

Purpose: Use of online contact force (CF) measurement during circumferential pulmonary vein (PV) isolation (CPVI) for atrial fibrillation (AF) has demonstrated improvements in procedural parameters and mid-term clinical outcome. However, it is unknown if experience gained with CF measuring catheters improves the efficacy of subsequent CPVI procedures performed without CF measurement.
Methods: This prospective trial compared procedural results of CPVI performed without a CF measuring catheter to a control group performed with a CF measuring catheter, by an operator with prior experience with CF technology..
Results: Thirty-six eligible paroxysmal (n = 27) or persistent (n = 9) AF patients were consecutively enrolled. Twelve patients underwent CPVI with the non-CF catheter (CF- group) in a recall period and 24 with the CF catheter (CF+ group). After the first circumferential lesion set, the number of PV pairs requiring additional touch-up lesions to achieve electrical isolation was significantly less in the CF+ group (2 of 48 (4.2 %) vs. 7 of 24 (29.2 %) in the CF+ and CF- groups, respectively, p = 0.005). The procedure time was significantly lower in the CF+ group (117.9 ± 23.3 vs. 134.1 ± 25.3 min, p = 0.033). Radiofrequency (RF) and fluoroscopy time did not differ between groups (31.5 ± 7.1 vs. 31.8 ± 7.0 min and 11.8 ± 5.6 vs. 11.0 ± 5.8 min in the CF+ and the CF- group, respectively)
Conclusions: With the use of online CF measurement, PV isolation is more frequently complete following the first circumferential lesion set. A previous learning period with direct CF feedback is not a substitute for real-time direct CF measurement to maintain this advantage.