Author + information
- Received July 24, 2017
- Revision received December 8, 2017
- Accepted December 11, 2017
- Published online April 16, 2018.
- Anthony Aizer, MD, MSc∗ (, )
- Austin V. Cheng, BS,
- Patrick B. Wu, MD,
- Jessica K. Qiu, BS,
- Chirag R. Barbhaiya, MD,
- Steven J. Fowler, MD,
- Scott A. Bernstein, MD,
- David S. Park, MD,
- Douglas S. Holmes, MD and
- Larry A. Chinitz, MD
- New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Medical Center, New York, New York
- ↵∗Address for correspondence:
Dr. Anthony Aizer, NYU Heart Rhythm Center, New York University Langone Medical Center, Tisch Hospital, Electrophysiology Laboratory, 560 First Avenue, 5th Floor, New York, New York 10016.
Objectives This study sought to investigate the effect of pacing mediated heart rate modulation on catheter–tissue contact and impedance reduction during radiofrequency ablation in human atria during atrial fibrillation (AF) ablation.
Background In AF ablation, improved catheter–tissue contact enhances lesion quality and acute pulmonary vein isolation rates. Previous studies demonstrate that catheter–tissue contact varies with ventricular contraction. The authors investigated the impact of modulating heart rate on the consistency of catheter–tissue contact and its effect on lesion quality.
Methods Twenty patients undergoing paroxysmal AF ablation received ablation lesions at 15 pre-specified locations (12 left atria, 3 right atria). Patients were assigned randomly to undergo rapid atrial pacing for either the first half or the second half of each lesion. Contact force and ablation data with and without pacing were compared for each of the 300 ablation lesions.
Results Compared with lesion delivery without pacing, pacing resulted in reduced contact force variability, as measured by contact force SD, range, maximum, minimum, and time within the pre-specified goal contact force range (p < 0.05). There was no difference in the mean contact force or force–time integral. Reduced contact force variability was associated with a 30% greater decrease in tissue impedance during ablation (p < 0.001).
Conclusions Pacing induced heart rate acceleration reduces catheter–tissue contact variability, increases the probability of achieving pre-specified catheter–tissue contact endpoints, and enhances impedance reduction during ablation. Modulating heart rate to improve catheter–tissue contact offers a new approach to optimize lesion quality in AF ablation. (The Physiological Effects of Pacing on Catheter Ablation Procedures to Treat Atrial Fibrillation [PEP AF]; NCT02766712)
Dr. Aizer serves as a consultant for Biosense Webster. Dr. Barbhaiya has received speaking fees/honoraria from Medtronic, Inc., Abbott, Inc., and Zoll, Inc. Dr. Chinitz serves as a consultant for Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received July 24, 2017.
- Revision received December 8, 2017.
- Accepted December 11, 2017.
- 2018 American College of Cardiology Foundation