Atrioventricular Nodal Re-entrant Tachycardia Ablations Using Contact Force: A Randomised Control Trial

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Cardiac catheter ablation using radiofrequency (heating energy) is a common treatment for heart rhythm disorders. Catheters are long flexible tubes with electrodes at the tip placed in the heart and deliver heating or cooling thermal injury to disrupt abnormal electrical circuits in the heart (ablation). Radiofrequency ablation can be performed using catheters which are flushed continuously with water (irrigated) or with non-irrigated catheters which are dry. The benefits of irrigated catheters are that they can create larger and deeper injury to the abnormal circuits which may be more effective as the water prevents overheating. Importantly, irrigated catheters also have technology which determines if the catheter has adequate contact or pressure with the cardiac tissue it is ablating, known as contact force. This is vital in achieving a stable position to facilitate effective ablation. Failure to apply enough pressure or energy to the heart tissue consistently can result in poor quality ablation lesions and recurrence of the abnormal heart rhythm. Non-irrigated catheters do not have contact-force sensing capabilities. Catheter ablation is an effective treatment for a fast heart rhythm condition called atrioventricular nodal reentrant tachycardia (AVNRT). Traditionally, ablation has been performed with non-irrigated non-contact force-sensing catheters but more recently due to the benefits of irrigated and contact force-sensing catheters, more operators have been using them. Whilst initially there was concern larger lesions could potentially lead to higher risk of damaging the atrioventricular node, a vital electrical structure in the heart, multiple studies have shown irrigated contact force-sensing catheters are safe to use for this condition and may be even safer than non-irrigated non-contact force-sensing catheters. However, the benefits of contact force-sensing catheter ablation for AVNRT have not been evaluated in high-level evidence studies. A randomised control study is the gold-standard in comparing 2 treatments in research. We will be conducting a randomised trial comparing the effect contact force-sensing catheter ablation has during AVNRT ablation to non-contact force-sensing ablation. There will be 2 treatment groups of equal size with 51 in each for total of 102 patients. All patients will undergo AVNRT ablation using an irrigated contact force-sensing catheter. In half the group, the operator will not know the contact force and perform the procedure as per conventional standard practice. In the other half, the operator will know the contact force during ablation. This is to assess if contact force can make procedures faster, safer and more effective in treating AVNRT which will benefit future patients. Another goal is also to see if junctional rhythm (a finding suggestive of successful ablation) correlates with adequate pressure or contact force during ablation.

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