Author + information
- Received October 23, 2017
- Revision received March 12, 2018
- Accepted March 22, 2018
- Published online June 18, 2018.
- Nilshan Ariyarathna, BSc(Med)/MBBS, MMed (Clin Epi)a,
- Saurabh Kumar, BSc(Med)/MBBS, PhDb,
- Stuart P. Thomas, BMed, PhDb,
- William G. Stevenson, MDc and
- Gregory F. Michaud, MDc,∗ ()
- aCardiology Department, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
- bDepartment of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
- cArrhythmia and Electrophysiology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- ↵∗Address for correspondence:
Prof. Gregory F. Michaud, Arrhythmia and Electrophysiology Program, Department of Medicine, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, Tennessee.
Adequate catheter-tissue contact facilitates efficient heat energy transfer to target tissue. Tissue contact is thus critical to achieving lesion transmurality and success of radiofrequency (RF) ablation procedures, a fact recognized more than 2 decades ago. The availability of real-time contact force (CF)–sensing catheters has reinvigorated the field of ablation biophysics and optimized lesion formation. The ability to measure and display CF came with the promise of dramatic improvement in safety and efficacy; however, CF quality was noted to have just as important an influence on lesion formation as absolute CF quantity. Multiple other factors have emerged as key elements influencing effective lesion formation, including catheter stability, lesion contiguity and continuity, lesion density, contact homogeneity across a line of ablation, spatiotemporal dynamics of contact governed by cardiac and respiratory motion, contact directionality, and anatomic wall thickness, in addition to traditional ablation indices of power and RF duration. There is greater appreciation of surrogate markers as a guide to lesion formation, such as impedance fall, loss of pace capture, and change in unipolar electrogram morphology. In contrast, other surrogates such as tactile feedback, catheter motion, and electrogram amplitude are notably poor predictors of actual contact and lesion formation. This review aims to contextualize the role of CF sensing in lesion formation with respect of the fundamental principles of biophysics of RF ablation and summarize the state-of-the-art evidence behind the role of CF in optimizing lesion formation.
- atrial fibrillation
- atrial flutter
- catheter ablation
- contact force
- impedance fall
- pace capture
- ventricular tachycardia
Dr. Kumar is a recipient of the Neil Hamilton Fairley Overseas Research scholarship, cofunded by the National Health and Medical Research Council and the National Heart Foundation of Australia, and the Bushell Travelling Fellowship, funded by the Royal Australasian College of Physicians. Dr. Stevenson is co-holder of a patent for needle ablation that is consigned to Brigham and Women’s Hospital; his spouse receives research support from St. Jude Medical; and has received speaker honoraria from Boston Scientific and Biosense Webster. Dr. Michaud has received consulting fees/honoraria from Boston Scientific, Biotronik, Medtronic, and Abbott/St. Jude Medical; and has received research funding from Boston Scientific and Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Ariyarathna and Kumar contributed equally to this work and are joint first authors.
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 October 23, 2017.
- Revision received March 12, 2018.
- Accepted March 22, 2018.
- 2018 American College of Cardiology Foundation
- Central Illustration
- Key Determinants of Lesion Size
- Importance of CF to Lesion Size and Ablation Efficacy: Evidence From Ex Vivo and In Vivo Nonhuman Experiments
- Importance of CF for Ablation Safety: Evidence From Experimental and Human Studies
- Importance of CF on Lesion Size, Ablation Efficacy, and Safety: Evidence From Human Studies
- Optimizing CF to Maximize Ablation Safety and Efficacy: Evidence From Clinical Studies
- The Role of Other Surrogate Markers for Assessing Lesion Completeness
- Role of CF Sensing in Ventricular Arrhythmias