Skip to main content
SpringerLink
Log in

The impact of steerable sheaths on unblinded contact force during catheter ablation for atrial fibrillation

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to evaluate the impact of steerable sheaths on multiple contact force parameters during atrial fibrillation (AF) ablation. Steerable sheaths are commonly used during AF ablation, at an additional cost to standard fixed-curve sheaths. However, there is little data on their incremental value in the era of contact force-guided radiofrequency ablation.

Methods

This multi-center cohort study included consecutive patients undergoing index pulmonary vein (PV) isolation with a force-sensing catheter. Operators employed either only steerable or only fixed-curve sheaths. Operators targeted a force of 10–40 g for each ablation lesion. Automated ablation lesion assessment software with standardized settings was employed.

Results

Of 85 subjects, 52 and 33 underwent ablation with steerable and fixed-curve sheaths, respectively. The steerable sheath group showed significantly higher average and maximum forces, but predominantly for the right PVs. The proportion of lesions with ≥ 10% of time with less than 10 g of force was lower in the steerable sheath group (adjusted odds ratio 0.56, steerable vs. fixed; 95% confidence interval 0.35, 0.89, p = 0.01). Improved stability was seen in the posterior aspect of both PV pairs. The proportion of RF time-in-target (the proportion of RF time meeting lesion criteria) was not different between the two groups (p = 0.176).

Conclusions

Even with contemporary contact force targets, steerable sheath use in AF ablation is associated with better average and maximum contact force and increased stability in comparison to fixed-curve sheaths.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Karch MR, Zrenner B, Deisenhofer I, Schreieck J, Ndrepepa G, Dong J, et al. Freedom from atrial tachyarrhythmias after catheter ablation of atrial fibrillation: a randomized comparison between 2 current ablation strategies. Circulation. 2005;111(22):2875–80. doi: CIRCULATIONAHA.104.491530. https://doi.org/10.1161/CIRCULATIONAHA.104.491530.

    Article  PubMed  Google Scholar 

  2. Oral H, Knight BP, Tada H, Ozaydin M, Chugh A, Hassan S, et al. Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation. 2002;105(9):1077–81.

    Article  Google Scholar 

  3. Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen S-A, et al. HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Heart Rhythm. 2012. 2012;9(4):632–96.e21. https://doi.org/10.1016/j.hrthm.2011.12.016.

    Article  PubMed  Google Scholar 

  4. Camm AJ, Lip GYH, De Caterina R, Savelieva I, Atar D, Hohnloser SH, et al. 2012 Focused update of the ESC guidelines for the management of atrial fibrillation. An update of the 2010 ESC guidelines for the management of atrial fibrillation developed with the special contribution of the European Heart Rhythm Association. Eur Heart J. 2012;33(21):2719–47. https://doi.org/10.1093/eurheartj/ehs253.

    Article  PubMed  Google Scholar 

  5. Verma A, Macle L, Cox J, Skanes AC. Canadian Cardiovascular Society Atrial Fibrillation Guidelines 2010: catheter ablation for atrial fibrillation/atrial flutter. Can J Cardiol. 2011;27(1):60–6. https://doi.org/10.1016/j.cjca.2010.11.011.

    Article  PubMed  Google Scholar 

  6. Piorkowski C, Eitel C, Rolf S, Bode K, Sommer P, Gaspar T, et al. Steerable versus nonsteerable sheath technology in atrial fibrillation ablation: a prospective, randomized study. Circ Arrhythm Electrophysiol. 2011;4(2):157–65. https://doi.org/10.1161/CIRCEP.110.957761.

    Article  PubMed  Google Scholar 

  7. Kuck KH, Reddy VY, Schmidt B, Natale A, Neuzil P, Saoudi N, et al. A novel radiofrequency ablation catheter using contact force sensing: Toccata study. Heart Rhythm. 2012;9(1):18–23. https://doi.org/10.1016/j.hrthm.2011.08.021.

    Article  PubMed  Google Scholar 

  8. Natale A, Reddy VY, Monir G, Wilber DJ, Lindsay BD, McElderry HT, et al. Paroxysmal AF catheter ablation with a contact force sensing catheter: results of the prospective, multicenter SMART-AF trial. J Am Coll Cardiol. 2014;64(7):647–56. https://doi.org/10.1016/j.jacc.2014.04.072.

    Article  PubMed  Google Scholar 

  9. Yokoyama K, Nakagawa H, Shah DC, Lambert H, Leo G, Aeby N, et al. Novel contact force sensor incorporated in irrigated radiofrequency ablation catheter predicts lesion size and incidence of steam pop and thrombus. Circ Arrhythm Electrophysiol. 2008;1(5):354–62. https://doi.org/10.1161/CIRCEP.108.803650.

    Article  PubMed  Google Scholar 

  10. Reddy VY, Dukkipati SR, Neuzil P, Natale A, Albenque JP, Kautzner J, et al. Randomized, controlled trial of the safety and effectiveness of a contact force-sensing irrigated catheter for ablation of paroxysmal atrial fibrillation: results of the TactiCath contact force ablation catheter study for atrial fibrillation (TOCCASTAR) study. Circulation. 2015;132(10):907–15. https://doi.org/10.1161/CIRCULATIONAHA.114.014092.

    Article  PubMed  Google Scholar 

  11. Masuda M, Fujita M, Iida O, Okamoto S, Ishihara T, Nanto K, et al. Steerable versus non-steerable sheaths during pulmonary vein isolation: impact of left atrial enlargement on the catheter-tissue contact force. J Interv Card Electrophysiol. 2016;47(1):99–107. https://doi.org/10.1007/s10840-016-0135-4.

    Article  PubMed  Google Scholar 

  12. Shah DC, Namdar M. Real-time contact force measurement: a key parameter for controlling lesion creation with radiofrequency energy. Circ Arrhythm Electrophysiol. 2015;8(3):713–21. https://doi.org/10.1161/CIRCEP.115.002779.

    Article  PubMed  Google Scholar 

  13. Ullah W, Schilling RJ, Wong T. Contact force and atrial fibrillation ablation. J Atr Fibrillation. 2016;8(5):1282. https://doi.org/10.4022/jafib.1282.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Neuzil P, Reddy VY, Kautzner J, Petru J, Wichterle D, Shah D, et al. Electrical reconnection after pulmonary vein isolation is contingent on contact force during initial treatment: results from the EFFICAS I study. Circ Arrhythm Electrophysiol. 2013;6(2):327–33. https://doi.org/10.1161/CIRCEP.113.000374.

    Article  PubMed  Google Scholar 

  15. Rajappan K, Baker V, Richmond L, Kistler PM, Thomas G, Redpath C, et al. A randomized trial to compare atrial fibrillation ablation using a steerable vs. a non-steerable sheath. Europace. 2009;11(5):571–5. https://doi.org/10.1093/europace/eup069.

    Article  PubMed  Google Scholar 

  16. Kautzner J, Neuzil P, Lambert H, Peichl P, Petru J, Cihak R, et al. EFFICAS II: optimization of catheter contact force improves outcome of pulmonary vein isolation for paroxysmal atrial fibrillation. Europace. 2015;17(8):1229–35. https://doi.org/10.1093/europace/euv057.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ullah W, McLean A, Tayebjee MH, Gupta D, Ginks MR, Haywood GA, et al. Randomized trial comparing pulmonary vein isolation using the SmartTouch catheter with or without real-time contact force data. Heart Rhythm. 2016;13(9):1761–7. https://doi.org/10.1016/j.hrthm.2016.05.011.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported through funding from the Division of Cardiology, University of British Columbia. Drs. Deyell, Laksman, and Andrade are recipients of Career Investigator Awards from the Michael Smith Foundation for Health Research (British Columbia, Canada).

We would like to thank Colin Magor, Product Specialist, Biosense-Webster Canada, for his technical support with extraction of the contact force data.

Author information

Authors and Affiliations

  1. Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, #211-1033 Davie Street, Vancouver, BC, V6E 1M7, Canada

    Marc W. Deyell, Glen Wen, Zachary Laksman, Matthew T. Bennett, Santabhanu Chakrabarti, John A. Yeung-Lai-Wah, Andrew D. Krahn & Jason G. Andrade

Authors
  1. Marc W. Deyell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Glen Wen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zachary Laksman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matthew T. Bennett
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Santabhanu Chakrabarti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. John A. Yeung-Lai-Wah
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Andrew D. Krahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jason G. Andrade
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Dr. Deyell was responsible for the study design and concept, data analysis, and interpretation and drafting of the manuscript. Dr. Wen was responsible for the study design, data analysis, and revision of the manuscript. Drs. Bennett, Chakrabarti, Yeung-Lai-Wah, and Krahn were responsible for the study concept and critical revision of the manuscript. Dr. Andrade was responsible for the study design, data interpretation, and critical revision of the manuscript. All authors approved the final version.

Corresponding author

Correspondence to Marc W. Deyell.

Ethics declarations

Conflict of interest

Dr. Deyell has received research funding and honoraria from Biosense-Webster. Dr. Laksman has received research funding from Abbott Medical. Dr. Andrade has received research funding from Medtronic and Baylis Medical.

Ethics approval and informed consent

This study was approved by the human ethics institutional review board at our institutions. Waiver of consent was granted for this study on the basis of minimal risk. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Deyell, M.W., Wen, G., Laksman, Z. et al. The impact of steerable sheaths on unblinded contact force during catheter ablation for atrial fibrillation. J Interv Card Electrophysiol 57, 417–424 (2020). https://doi.org/10.1007/s10840-019-00514-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-019-00514-1

Keywords

Search

Navigation