Recurrence after pulmonary vein isolation is associated with low contact force

Objectives. Recurrent arrhythmia after pulmonary vein isolation (PVI) by radiofrequency (RF) ablation in patients with atrial fibrillation (AFIB) remains a significant challenge. Using contact force (CF) sensing ablation catheters, we aimed to identify procedure related parameters associated with recurrence after de-novo PVI in patients with AFIB. Methods. Consecutive patients undergoing a de-novo PVI procedure (n=120, 63% paroxysmal and 37% persistent AFIB) employing a force-sensing ablation catheter were included. A clinical control including electrocardiogram and 120hour of Holter-recording at 12-months was performed in all patients. Recurrence was defined as any documented AFIB or atrial flutter more than 30seconds on Holter-recording after an initial blanking period of three months. Results. Recurrence occurred in 44 patients (37%). Mean CF was lower in patients with recurrent arrhythmia (22.2 +/- 9.5 vs. 28.8 +/- 9.3g, p<.001). In multi-variable analyses lower mean CF (OR 0.9 (95% CI 0.8-1.0), p=.03), and higher percentage of ablation time with a CF <10 grams (OR 1.1 (95% CI 1.0-1.1), p=.004) were both associated with recurrence in two distinct models. Dragging during ablation compared with point-by-point ablation technique was associated with recurrence in both models (OR 19.2 (95% CI 2.9-130.0), p=.002, and OR 21.7 (95% CI 2.7-176.2), p=.004). Conclusions. Low CF and dragging during ablation as compared with point-by-point ablation technique were associated with recurrent arrhythmia in patients with AFIB undergoing de-novo PVI by RF ablation.