A prospective study on safety of catheter ablation procedures: Contact force guided ablation could reduce the risk of cardiac perforation

Background: Contact force (CF) sensing catheters provide advantages with regard to safety and efficacy. This study aimed to evaluate if CF catheters reduce cardiac perforations and other major complications and offer equal safety compared to the magnetic navigation system (MNS). Methods: Data from 1.517 ablation procedures from our prospective registry was analyzed. Ablations were performed using either CF guided catheters (CF group, n = 248), non-CF catheters (NCF group, n = 813), or MNS (n = 456). Four subgroups were analyzed: atrial fibrillation (AF, n = 557), supraventricular tachycardia (SVT, n = 715), ventricular tachycardia (VT, n = 190) and patients with congenital heart defects (CHD, n = 55). The primary endpoint of this study was incidence of cardiac perforation. Secondary endpoints were major and minor complications within 30 days of the procedure. Results: Complications occurred in 11.3% (n = 172) of the procedures. In 2.8% (n = 43) a major complication occurred, 0.9% (n = 13) had a perforation, 8.5% (n = 129) had a minor complication and 2 patients died (0.1%). No cardiac perforation occurred in the CF group, which was significantly different from NCF procedures (0.0% vs. 1.6%; relative risk 0.76, 95% CI 0.74-0.79, P = 0.031) and equal to MNS (0.0%). This was also observed in the AF subgroup (0.0% vs. 3.3%; RR 0.67, 95% CI 0.63-0.72, P = 0.021), and the occurrence of major complications was lower for CF versus NCF procedures (2.1% vs. 7.8%, P = 0.010). Conclusions: CF-guided catheter ablation is superior to NCF with regard to procedural safety and avoidance of cardiac perforation. This difference is due to a reduction of cardiac perforation and major complications in the AF subgroup. (C) 2014 Elsevier Ireland Ltd. All rights reserved.