Choice of Steerable Sheath Impacts Contact Force Stability during Pulmonary Vein Isolation

Evan Hiner, Dipak P. Shah

Research output: Contribution to journalArticlepeer-review

Abstract

A stable contact force (CF) is correlated with more effective radiofrequency (RF) 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. Thirty patients underwent first-Time RFA at a single center using the Agilis NxT (Abbott, Chicago, IL, USA) or SureFlex (Baylis Medical, Montreal, Canada) steerable sheath. High-power short-duration RFA was utilized, targeting a 10-? 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 a CF of less than 5 g for at least 10% of the RF delivery time). The operator-Targeted mean CF was achieved using both sheaths; however, the overall CF variability was 12.8% lower when using the SureFlex sheath (p = 0.08). The 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 created when using the Agilis sheath as compared to the SureFlex sheath (p = 0.035), especially in the right inferior PV (p = 0.009). The RF time per lesion was, on average, 12% (1.4 seconds) shorter when using the SureFlex sheath than the Agilis sheath (p 0.05). The choice of steerable sheath may affect both catheter stability and lesion quality, especially in the right PVs.

Original languageEnglish (US)
Pages (from-to)4790-4795
Number of pages6
JournalJournal of Innovations in Cardiac Rhythm Management
Volume12
Issue number12
DOIs
StatePublished - Dec 2021
Externally publishedYes

Keywords

  • Ablation
  • atrial fibrillation
  • catheter stability
  • contact force
  • pulmonary vein isolation
  • steerable sheath.

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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