Feasibility and safety of high-power ablation of atrial fibrillation with contact force-sensing catheter: The lesion size index-guided ablation

Background. Radiofrequency (RF) ablation is a commonly used method of atrial fibrillation (AF) treatment. High-power short-duration (HPSD) ablation has been suggested as a method to reduce procedure times whilst creating safe and lasting lesions. High-power ablation with contact force (CF)-sensing technology catheters might aid in a further improvement of safety whilst generating lasting transmural lesions. Objectives. We report our experience using lesion size index (LSI)-guided 50 W ablation with a CF-sensing catheter of AF. Materials and methods. We performed LSI-guided 50 W point-by-point ablation using a CF-sensing catheter (TactiCath). Target LSI at the anterior left atrium (LA) was 5.0 and at the posterior LA it was 4.5. Results. Altogether, 4641 RF lesions were created in 86 consecutive patients. To reach a mean LSI of 4.9 +/- 0.01, a mean RF ablation time of 14.3 +/- 0.1 s was applied with a mean CF of 13.4 +/- 0.1 g. The RF time per lesion at the anterior wall of LA was 15.9 +/- 0.2 s, while it was 13 +/- 0.2 s at the posterior wall of LA. We observed force time integral (FTI) values between 36 g and 310 g. Procedure duration was 107 +/- 4 min with a RF ablation time of 15.4 +/- 0.6 min. No audible steam pops occurred. No pericardial effusion was observed. After a 1-year follow-up, no adverse events were reported and 83% of patients had no symptomatic arrhythmia recurrence. Conclusions. We provide evidence for the safety and efficacy of LSI-guided 50 W ablation using the TactiCath CF-sensing ablation catheter. These data support the use of high-power ablation with CF sensing technology to improve both safety and efficacy.