Use of electrical coupling information in AF catheter ablation: A prospective randomized pilot study

BACKGROUND Catheter contact is important for radiofrequency (RE) ablation. Local electrical catheter-to-tissue coupling has been described as a toot to objectively measure contact. OBJECTIVE We hypothesized that pulmonary vein isolation (PVI) ablation using electrical coupling information (ECI) would yield higher rates of PVI than an approach without ECI. METHODS Forty patients with atrial fibrillation were prospectively included. In each patient, 1 pair of pulmonary veins (PVs) was randomly chosen to be encircled with ECI available while the other pair was encircled without use of ECI. RESULTS The rate of PVI was significantly higher in PVs encircled with ECI available (58% vs 30%; P = .024). PV encircling with coupling resulted in slightly longer procedure (26.5 [interquartile range {IQR} 22-32.5] vs 23.5 [IQR 19-26.5] minutes; P = .019), fluoroscopy (9.0 [IQR 6-12] vs 6.9 [IQR 4-8.6] minutes; P = .011), and RE (20.0 [IQR 16.5-23.5] vs 17.3 [IQR 15.1-20.6] minutes; P = .015) times. For nonisolated PVs, the coupling group had significantly fewer gaps (3.0 [IQR 1.8-7] vs 6.0 [IQR 4-11]; P = 0.021) and gap mapping/closure needed shorter procedure (9.0 [IQR 4-16] vs 13.0 [IQR 11-21] minutes; P = .04), fluoroscopy (3.9 [IQR 2-7.1] vs 6.0 [IQR 4.6-7.9] minutes; P = .038), and RE (1.9 [IQR 0.9-5] vs 5.2 [IQR 3.3-8.6] minutes; P = .016) times. CONCLUSIONS The use of ECI improved lesion deployment measured as higher rates of PVI after anatomical encircling. For nonisolated PVs, fewer gaps and faster gap closure were found using ECI.