Abstract
Purpose: A stable contact force (CF) is correlated with more
effective radiofrequency ablation (RFA) lesions and long-term procedural
outcomes. Efforts to improve catheter stability include jet ventilation,
pacing, steerable sheaths, and CF sensing ablation catheters. This study
compares CF stability and effective RF lesions between two commercially
available steerable sheaths.
Methods: Thirty patients underwent first time RFA at a single
center using the Agilis NxT or SureFlex Steerable Sheath. High power
short duration RFA was utilized targeting a 10Ω drop. Sheath performance
was assessed for the entire procedure and around each pulmonary vein
(PV) in terms of mean CF, CF variability, RF time per lesion, and
inefficient contact lesions (defined as lesions with CF < 5g
for at least 10% of the RF delivery time).
Results: Operator-targeted mean CF was achieved using both
sheaths; however, overall CF variability was 12.8% lower using the
SureFlex sheath (p = 0.08). CF variability was generally 16% greater in
the right PVs than the left PVs (p = 0.001), but trended lower with the
SureFlex sheath. There were 8% more inefficient contact lesions using
Agilis as compared to SureFlex (p = 0.035), especially in the right
inferior PV (p = 0.009). RF time per lesion was on average 12% (1.4s)
shorter using SureFlex than Agilis (p < 0.05).
Conclusion: Choice of steerable sheath may affect
catheter stability and potential lesion quality, especially in the right
PVs.
Keywords: pulmonary vein isolation, ablation, atrial
fibrillation, contact force, catheter stability, steerable sheath