Recurrent atrial arrhythmia in a randomized controlled trial comparing
contact force guided and contact force blinded ablation for typical
atrial flutter
Abstract
Background: Contact force (CF) guided catheter ablation (CA) is a novel
technology developed to improve efficacy and reduce complications. In a
randomised controlled trial (RCT), we previously documented that after
three months, rate of persistent conduction block was similar with and
without using CF while performing CA for typical atrial flutter (AFL).
Clinical effect of CF on recurrent arrhythmia is unknown. Objective: To
study recurrent atrial arrhythmia during 12-months follow-up in a RCT
investigating whether CF-guided CA for typical AFL is superior to
CF-blinded CA. Method: Patients were randomized 1:1 to CA guided by CF
(intervention group) or blinded to CF (control group). After 12 months,
patients attended clinical check-up preceded by a 5-day ambulatory
Holter monitor recording. Primary outcome was any recurrent atrial
arrhythmia ≥30 seconds within 12 months, symptomatic or asymptomatic and
documented in 12-lead ECG or Holter monitor recording. We did
intention-to-treat (ITT) analysis. Results: We included and randomized
156 patients, four patients withdrew consent and two died during
follow-up. Thus, 150 patients were included in ITT-analysis, in which
recurrent arrhythmia was detected in 47 (31%) patients, 25 in the
intervention group and 22 in the control group (p = 0.25). Atrial
fibrillation was detected in 38 patients (18 versus 20 patients), and
AFL in the remaining 9 patients (7 versus 2 patients). Conclusion:
Contact force guided ablation for typical atrial flutter does not reduce
recurrent atrial arrhythmia after 12-months follow-up as compared with
ablation blinded for contact force.