\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}


\usepackage{authblk}


\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[ngerman,english]{babel}



\usepackage{float}








\begin{document}

\title{Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia with
an Irrigated Contact Force Sensing Radiofrequency Ablation Catheter}



\author[1]{Priya Panday}%
\author[1]{Douglas Holmes}%
\author[1]{David Park}%
\author[1]{Lior Jankelson}%
\author[1]{Scott Bernstein}%
\author[1]{Robert Knotts}%
\author[1]{Alexander Kushnir}%
\author[1]{Anthony Aizer}%
\author[1]{Larry Chinitz}%
\author[1]{Chirag  Barbhaiaya}%
\affil[1]{New York University Leon H Charney Division of Cardiology}%


\vspace{-1em}



  
  \date{May 18, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup





\selectlanguage{english}
\begin{abstract}
\textbf{Introduction}: Radiofrequency ablation (RFA) slow pathway
modification for catheter ablation of AV nodal reentrant tachycardia
(AVNRT) is traditionally performed using a 4mm, non-irrigated (NI) RF
ablation catheter. Slow pathway modification using irrigated,
contact-force sensing (ICFS) RFA catheters has been described in case
reports, but outcomes have not been systematically evaluated.
\textbf{Methods}: Acute procedural outcomes of 200 consecutive patients
undergoing slow pathway modification for AVNRT were analyzed. An ICFS
3.5mm RFA catheter (ThermoCool SmartTouch STSF, Biosense Webster, Inc.)
was utilized in 134 patients, and a 4mm NI RFA catheter (EZ Steer,
Biosense Webster, Inc.) was utilized in 66 patients. Electroanatomic
maps were retrospectively analyzed in a blinded fashion to determine
proximity of ablation lesions to the His region. \textbf{Results}:
Baseline characteristics of patients in both groups were similar. Total
RF time was significantly lower in the ICFS group compared to the NI
group (5.53\selectlanguage{ngerman}±4.6 vs. 6.24±4.9 min, p=0.03). Median procedure time was
similar in both groups, ICFS 108.0 (87.5-131.5) vs. NI 100.0
(85.0-125.0) min, p=0.2). Ablation was required in closer proximity to
the His region in the NI group compared to the ICFS group (14.4 ± 5.9 mm
vs, 16.7 ± 6.4 mm, respectively, p=0.01). AVNRT was rendered
non-inducible in all patients, and there was no arrhythmia recurrence
during follow-up in both groups. Catheter ablation was complicated by AV
block in one patient in the NI group. \textbf{Conclusion}: Slow pathway
modification for catheter ablation of AVNRT using an irrigated,
contact-force sensing RFA catheter is feasible, safe, and may facilitate
shorter duration ablation while avoiding ablation in close proximity to
the His region.%
\end{abstract}\selectlanguage{ngerman}%



\sloppy


\textbf{Catheter Ablation of Atrioventricular Nodal Reentrant
Tachycardia with an Irrigated Contact Force Sensing Radiofrequency
Ablation Catheter}

Priya Panday, MD

Douglas Holmes, MD

David S. Park, MD, PhD

Lior Jankelson, MD

Scott A. Bernstein, MD

Robert Knotts, MD

Alexander Kushnir, MD, PhD

Anthony Aizer, MD, MS

Larry A. Chinitz, MD

Chirag R. Barbhaiya, MD

Leon H. Charney Division of Cardiology, New York University Grossman
School of Medicine, New York University Langone Health. New York, NY,
USA.

\textbf{Corresponding Author:}

Dr. Chirag Barbhaiya

Leon H. Charney Division of Cardiology

New York University School of Medicine

550 1st Avenue

New York, NY 10016, USA

Phone: 212-263-5555

Fax: 212-263-8685

E-mail address: chirag.barbhaiya@nyulangone.org

\textbf{Disclosures:} Relationships to industry are all modest
(\textless{} \$10,000). Dr. Barbhaiya has received speaking
fees/honoraria from Biosense Webster, Inc., Abbott, Inc. and Zoll, Inc.
Dr. Aizer receives fellowship support from Abbott, Inc., Biotronik,
Inc., Boston Scientific, Inc., and Medtronic, Inc. Dr. Chinitz has
received speaking fees / honoraria from Abbott Medical, Inc., Medtronic,
Inc., Biotronik, Inc., Biosense Webster, Inc.

\textbf{Funding:} There was no funding for this work.

\textbf{Abstract:}

\textbf{Introduction} : Radiofrequency ablation (RFA) slow pathway
modification for catheter ablation of AV nodal reentrant tachycardia
(AVNRT) is traditionally performed using a 4mm, non-irrigated (NI) RF
ablation catheter. Slow pathway modification using irrigated,
contact-force sensing (ICFS) RFA catheters has been described in case
reports, but outcomes have not been systematically evaluated.

\textbf{Methods} : Acute procedural outcomes of 200 consecutive patients
undergoing slow pathway modification for AVNRT were analyzed. An ICFS
3.5mm RFA catheter (ThermoCool SmartTouch STSF, Biosense Webster, Inc.)
was utilized in 134 patients, and a 4mm NI RFA catheter (EZ Steer,
Biosense Webster, Inc.) was utilized in 66 patients. Electroanatomic
maps were retrospectively analyzed in a blinded fashion to determine
proximity of ablation lesions to the His region.

\textbf{Results} : Baseline characteristics of patients in both groups
were similar. Total RF time was significantly lower in the ICFS group
compared to the NI group (5.53\selectlanguage{ngerman}±4.6 vs. 6.24±4.9 min, p=0.03). Median
procedure time was similar in both groups, ICFS 108.0 (87.5-131.5) vs.
NI 100.0 (85.0-125.0) min, p=0.2). Ablation was required in closer
proximity to the His region in the NI group compared to the ICFS group
(14.4 ± 5.9 mm vs, 16.7 ± 6.4 mm, respectively, p=0.01). AVNRT was
rendered non-inducible in all patients, and there was no arrhythmia
recurrence during follow-up in both groups. Catheter ablation was
complicated by AV block in one patient in the NI group.

\textbf{Conclusion} : Slow pathway modification for catheter ablation of
AVNRT using an irrigated, contact-force sensing RFA catheter is
feasible, safe, and may facilitate shorter duration ablation while
avoiding ablation in close proximity to the His region.

\textbf{Keywords:} radiofrequency ablation, atrioventricular nodal
reentrant tachycardia, irrigated catheter, slow pathway modification

\textbf{Introduction} :

Radiofrequency ablation (RFA) is a safe and effective treatment option
for AV nodal reentrant tachycardia (AVNRT), and is most frequently
performed using a 4mm, non-irrigated (NI) RF ablation catheter in a
temperature-controlled mode, although use of irrigated RF ablation
catheters is increasingly common. The location of RF application for
slow pathway modification is selected to optimize efficacy while
maintaining a safe distance to the presumed location of the compact AV
node to minimize risk of creating AV block.\textsuperscript{1} Optimal
energy delivery during RFA requires stable contact at the
catheter-tissue interface. Utilization of irrigated, contact-force
sensing (ICFS) catheters has increased over time for a range of
indications.\textsuperscript{2-4} Availability of contact-force data
during ablation may facilitate effective ablation, while ablation
electrode irrigation may improve efficiency lesion creation,
particularly when power during NI RF ablation is limited by temperature
at the ablation electrode.

Although slow pathway modification using ICFS RFA catheters has been
described in case reports, outcomes have not been systematically
evaluated. The aim of this study is to compare acute outcomes of RF
ablation for slow pathway modification using a 3.5mm ICFS RFA catheter
to those using a NI 4mm RF ablation catheter.

\textbf{Methods} :

Retrospective chart review identified 200 consecutive patients who
underwent slow pathway modification for AVNRT between March 2019 and
June 2021. Patients were excluded from the study if they had prior
ablation, were undergoing an additional ablation at time of AVNRT
ablation or had unavailable mapping data. All available medical records,
including baseline characteristics, ECG, and electrophysiology study
were reviewed and analyzed by investigators. Data collection and
analysis was performed according to protocols approved by the NYU
Langone Health Institutional Review Board. Surface and intracardiac
electrograms (EGMs) were digitally recorded and stored (EP Workmate,
Abbott Medical, Inc.). All procedures were performed under conscious
sedation and AVNRT diagnosis was confirmed using established
criteria.\textsuperscript{5, 6} An ICFS 3.5mm RFA catheter (ThermoCool
SmartTouch STSF, Biosense Webster, Inc.) was utilized in 134 patients,
and a 4mm NI RFA catheter (EZ Steer, Biosense Webster, Inc.) was
utilized in 66 patients. NI RFA was performed with an initial power
setting of 50W in a temperature control mode and temperature limit 55°C
and RF generator in ``fast mode.'' ICFS RFA was performed in a power
control mode with an initial power setting of 35W and standard
irrigation settings and RF generator in ``STSF mode.'' Power settings
were not altered intraoperatively. Non-fluoroscopic 3-dimensional
mapping was performed using the Carto 3 (Biosense-Webster, Inc.,)
mapping system in all patients. Catheter ablation was considered acutely
successful if AVNRT was rendered noninducible, and there was \selectlanguage{english}[?] 1
inducible AV nodal reentrant echo beat with isoproterenol infusion up to
20mcg/min. Electroanatomic maps (EAM) were analyzed in a retrospective
fashion by blinded investigators to determine the shortest distance
between an EAM point with a His electrogram and the nearest ablation
lesion (His distance) as a surrogate marker of ablation-related AV
conduction injury risk (Figure 1). Intraprocedural data including
radiofrequency (RF) time, case length, fluoroscopy time and details of
electrophysiology study were collected and analyzed.

Patients were followed at least three months after the date of their
procedure. Patients received routine outpatient follow-up at 1-month
post-ablation and subsequently at the discretion of their referring
cardiologist. The primary outcomes were survival free of recurrent AVNRT
after slow pathway modification, and occurrence of major complications
including ablation related AV block. Secondary outcomes were procedure
duration, RF time, and shortest distance between the electroanatomic
mapping point with a His electrogram and the nearest ablation lesion.

Categorical data were analyzed across the 2 groups with the chi squared
test and were reported as frequencies and percentages. Continuous data
were analyzed using the Mann-Whitney U test and were reported as
mean\emph{+} standard deviation. SPSS Statistics software 25.0 (IBM,
Armonk, NY) was used for data analysis.

\textbf{Results} :

The baseline clinical characteristics of the 134 patients who underwent
NI RFA and 66 patients who underwent ICFS RFA were similar (Table 1).
Baseline electrophysiologic features of patients in both groups were
similar apart from obstructive sleep apnea (OSA) (Table 2). A steerable
sheath was used more frequently in patients who underwent ICFS catheter
ablation compared to patients who underwent ablation with a NI catheter
(88\% vs. 51\%, respectively, P\textless{}0.001). Six patients underwent
transseptal puncture in the ICFS group, as compared to two in the NI
groups. Total RF time was significantly lower in the ICFS group compared
to the NI group (5.5+-4.6 vs. 6.2+-4.9 min, p=0.03). Median procedure time
was similar in both groups, ICFS 108 (88-132) min vs. NI 100 (85 -125)
min, p=0.2). Ablation was required in closer proximity to the His region
in the NI group compared to the ICFS group (14 +- 6 mm vs, 17 +- 6 mm,
respectively, p=0.01). The proportion of cases in which ablation was
required within 1 cm of a location with a His electrogram was
significantly greater in the NI catheter group as compared to the ICFS
group (20\% vs. 9\%, respectively, p=0.04, Figure 2). AVNRT was
successfully rendered uninducible in all patients.

After ablation, patients had at-least one post-procedure outpatient
evaluation. There were no recurrent arrhythmias noted during the
follow-up period (Table 3). One patient in the NI ablation group
developed persistent AV block with a His distance of 17 mm, while there
were no cases of persistent AV block in the ICFS ablation group. There
were no vascular access complications, including AV fistula or hematoma,
in either cohort.

\textbf{Discussion}

In this large, recent cohort of patients undergoing catheter ablation of
AVNRT, procedural outcomes in both study groups were excellent, with no
incidence of arrhythmia recurrence during follow-up. There was no
evidence of increased risk of AV nodal injury with irrigated RF
ablation. Use of ICFS ablation catheter was associated with successful
ablation with decreased total ablation and decreased need for ablation
in close proximity to the His region.

A previous, smaller, uncontrolled study has shown favorable outcomes for
irrigated radiofrequency ablation of AVNRT.\textsuperscript{7} The
present study, shows similarly favorable outcomes in a larger cohort
using a catheter with contact-force sensing capability. A case of
inadequate NI RF ablation for slow pathway modification with subsequent
successfully ablation using an ICFS ablation catheter has been
previously reported.\textsuperscript{8} Our study comparing these
ablation modalities demonstrates that slow pathway modification may be
successfully achieved with shorter duration RF application, and less
ablation in close proximity to the His region with ICFS catheters
relative to NI ablation catheters.

Safety and efficacy of lesion creation with both utilized catheter may
be better understood by examining details of RF delivery for each
catheter. In vivo studies have demonstrated that lesion size is
proportional to current density at the ablation
electrode.\textsuperscript{9} The surface area of the ablation
electrodes of the utilized NI 4mm catheter and the 3.5mm ICFS catheter
38 mm\textsuperscript{2} and 31 mm\textsuperscript{2}, respectively
(catheter specifications obtained by personal correspondence with
medical affairs representative at Biosense Webster, Inc.). The resulting
power densities, which are proportional to current densities at a given
impedance, at goal 50W power with the 4mm NI catheter, and 35 W power
with the 3.5mm ICFS catheter are thus 1.3 W/ mm\textsuperscript{2}, and
1.1W/ mm\textsuperscript{2}, respectively. Additionally, ``fast mode''
utilized with RF generator during ablation with 4mm NI catheter, and
``STSF mode'' utilized with RF generator during ablation with 3.5mm ICFS
catheter, both result in achievement of goal power in
\textasciitilde{}3s if power delivery is not limited by electrode
temperature (RF generator specifications obtained by personal
correspondence with medical affairs representative at Biosense Webster,
Inc.). While irrigated RF ablation creates increased lesion diameter and
depth relative to NI RF ablation, the expected current density is
slightly lower using the ICFS compared to the NI catheter, and the
temporal characteristics if RF delivery are similar, thus lesion
creation under ideal conditions are likely similar with the two
approaches studied. The primary safety concern for adoption of ICFS
ablation is the possibility of greater risk of iatrogenic permanent AV
node block. We found no evidence of increased risk for iatrogenic AV
block with ICFS, with the single case of ablation related AV block in
our study cohort occurring in the NI ablation group. We hypothesize that
identification of inadequate contact-force results in reduced frequency
of ineffective RF application, while confirmation of adequate
contact-force during RF application and electrode irrigation to overcome
temperature-limited RF application facilitates effective lesion
creation, and successful ablation without encroachment of ablation
lesions into the region of the compact AV node. The substantially
decreased proportion of patients who required ablation within 10mm of
the His region suggests that risk of iatrogenic AV block may be lower
with ICFS ablation compared to NI ablation, although further studies are
required to confirm these findings.

\textbf{Limitations}

The non-randomized, single-center nature of the present study may limit
the generalizability of our findings. The consecutive nature of the
patients analyzed helps limit bias in the absence of randomization. All
cases were performed by one of 5 high-volume operators, and by the end
of the study period, all operators were routinely utilizing ICFS
catheters for all AVNRT ablation procedures. At our medical center,
increased utilization of a steerable sheath has paralleled increased
adoption of ICFS, thus some of the differences observed with ICFS may be
attributable the use of the steerable sheath. As AVNRT ablation
procedures tend to carry low complication rates, the study may not have
been sufficiently powered to evaluate risk of AV block.

\textbf{Conclusions}

Slow pathway modification for catheter ablation of AVNRT using an
irrigated, contact-force sensing RFA catheter is feasible, safe, may
require shorter duration ablation, and result in greater EAM distances
as compared to catheter ablation using a non-irrigated RFA catheter.
These findings require confirmation in larger, multicenter studies.

\textbf{References:}

1. Wittkampf FH, Nakagawa H. RF catheter ablation: Lessons on
lesions.\emph{Pacing Clin Electrophysiol} . Nov 2006;29(11):1285-97.
doi:10.1111/j.1540-8159.2006.00533.x

2. Calkins H, Epstein A, Packer D, et al. Catheter ablation of
ventricular tachycardia in patients with structural heart disease using
cooled radiofrequency energy: results of a prospective multicenter
study. Cooled RF Multi Center Investigators Group. \emph{J Am Coll
Cardiol} . Jun 2000;35(7):1905-14. doi:10.1016/s0735-1097(00)00615-x

3. Soejima K, Delacretaz E, Suzuki M, et al. Saline-cooled versus
standard radiofrequency catheter ablation for infarct-related
ventricular tachycardias. \emph{Circulation} . Apr 10
2001;103(14):1858-62. doi:10.1161/01.cir.103.14.1858

4. Chrispin J, Misra S, Marine JE, et al. Current management and
clinical outcomes for catheter ablation of atrioventricular nodal
re-entrant tachycardia. \emph{Europace} . Apr 1 2018;20(4):e51-e59.
doi:10.1093/europace/eux110

5. AlMahameed ST, Buxton AE, Michaud GF. New criteria during right
ventricular pacing to determine the mechanism of supraventricular
tachycardia. \emph{Circ Arrhythm Electrophysiol} . Dec 2010;3(6):578-84.
doi:10.1161/CIRCEP.109.931311

6. Bennett MT, Leong-Sit P, Gula LJ, et al. Entrainment for
distinguishing atypical atrioventricular node reentrant tachycardia from
atrioventricular reentrant tachycardia over septal accessory pathways
with long-RP {[}corrected{]} tachycardia. \emph{Circ Arrhythm
Electrophysiol} . Aug 2011;4(4):506-9. doi:10.1161/CIRCEP.111.961987

7. Bertini M, Brieda A, Balla C, et al. Efficacy and safety of catheter
ablation of atrioventricular nodal re-entrant tachycardia by means of
flexible-tip irrigated catheters. \emph{J Interv Card Electrophysiol} .
Jun 2020;58(1):61-67. doi:10.1007/s10840-019-00578-z

8. Contino CJ, Weiss M, Riley MP, Frisch DR. Atrioventricular Nodal
Reentrant Tachycardia Ablation with a Power-controlled, Contact-force
Catheter. \emph{J Innov Card Rhythm Manag} . Nov 2020;11(11):4297-4300.
doi:10.19102/icrm.2020.111103

9. Nath S, DiMarco JP, Haines DE. Basic aspects of radiofrequency
catheter ablation. \emph{J Cardiovasc Electrophysiol} . Oct
1994;5(10):863-76. doi:10.1111/j.1540-8167.1994.tb01125.x

\textbf{Tables:}

Table 1: Baseline patient characteristics (values are mean +- SD or n
(\%), unless otherwise noted)\selectlanguage{english}
\begin{longtable}[]{@{}llll@{}}
\toprule
\begin{minipage}[b]{0.22\columnwidth}\raggedright\strut
\textbf{Baseline Characteristics}\strut
\end{minipage} & \begin{minipage}[b]{0.22\columnwidth}\raggedright\strut
\textbf{Irrigated Contact-force Sensing Ablation Catheter (n=134)}\strut
\end{minipage} & \begin{minipage}[b]{0.22\columnwidth}\raggedright\strut
\textbf{Non irrigated catheter (n=66)}\strut
\end{minipage} & \begin{minipage}[b]{0.22\columnwidth}\raggedright\strut
\textbf{p value}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{Age (years)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
55\selectlanguage{ngerman}±18\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
60\selectlanguage{ngerman}±17\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
0.07\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\textbf{Male Gender (\%)}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
56 (42\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
25 (38\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
0.7\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{DM (\%)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
15 (11\%)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
13 (20\%)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
0.1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{HTN (\%)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
55 (41\%)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
36 (55\%)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
0.1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{CAD (\%)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
17 (13\%)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
14 (21\%)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
0.2\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{CVA/TIA (\%)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
4 (3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
3 (4.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
0.7\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{CHF (\%)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
3 (2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
2 (3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
0.7\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{OSA (\%)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
16 (12\%)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
2 (3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
0.04*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{COPD (\%)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
9 (7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
3 (5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
0.8\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

Table 2: Electrophysiologic Features (values are mean \selectlanguage{ngerman}± SD or n (\%),
unless otherwise noted)\selectlanguage{english}
\begin{longtable}[]{@{}llll@{}}
\toprule
\begin{minipage}[b]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.22\columnwidth}\raggedright\strut
\textbf{Irrigated Contact-force Ablation Catheter (n=134)}\strut
\end{minipage} & \begin{minipage}[b]{0.22\columnwidth}\raggedright\strut
\textbf{Non irrigated catheter (n=66)}\strut
\end{minipage} & \begin{minipage}[b]{0.22\columnwidth}\raggedright\strut
\textbf{p value}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{Pre-procedural EKG Data}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{Pre-procedural EKG Data}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{Pre-procedural EKG Data}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{Pre-procedural EKG Data}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{PR Interval}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
159\selectlanguage{ngerman}±26\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
159\selectlanguage{ngerman}±25\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
0.8\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{QRS Interval}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
86\selectlanguage{ngerman}±10\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
87\selectlanguage{ngerman}±13\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{RBBB}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
3\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
2\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
0.7\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{LBBB}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
1\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{Procedural Data}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{Procedural Data}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{Procedural Data}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{Procedural Data}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{Use of Agilis Catheter}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
119 (88\%)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
34 (51\%)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textless{}0.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{Trans-septal Puncture}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
6 (4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
2 (3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
0.6\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\textbf{A-H time (ms)}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
91\selectlanguage{ngerman}±22\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
83\selectlanguage{ngerman}±21\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
0.2\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{H-V time (ms)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
45\selectlanguage{ngerman}± 11\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
43\selectlanguage{ngerman}±7\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
0.7\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{Wenckebach Cycle Length (ms)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
386\selectlanguage{ngerman}±73\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
373\selectlanguage{ngerman}±68\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
0.2\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{Tachycardia Cycle Length (ms)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
335\selectlanguage{ngerman}±69\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
354\selectlanguage{ngerman}±66\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
0.2\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{RF time (min)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
5.5\selectlanguage{ngerman}±4.6\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
6.2\selectlanguage{ngerman}±4.9\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
0.03*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{Procedure Time (min) (median, IQR)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
108 (88-132)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
100 (85-125)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
0.2\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\textbf{Fluoro Dose (mGy)} \textbf{(median, IQR)}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
23\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
19.5\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
0.28\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{His distance (mm)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
16.7\selectlanguage{ngerman}±6.4\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
14.4\selectlanguage{ngerman}±5.9\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
0.007*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{His distance [?]10mm}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
12 (9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
13 (20\%)\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
0.04*\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

Table 3: Clinical Endpoint/Procedural Outcomes (values are n (\%))\selectlanguage{english}
\begin{longtable}[]{@{}llll@{}}
\toprule
& \textbf{Irrigated Contact-force Ablation Catheter (n=134)} &
\textbf{Non irrigated catheter (n=66)} & \textbf{p value}\tabularnewline
\midrule
\endhead
\textbf{Noninducible} & 134 (100\%) & 66 (100\%) & 1\tabularnewline
\textbf{Post-ablation Jump} & 18 (13\%) & 7 (11\%) & 0.7\tabularnewline
\textbf{Post-ablation Echo} & 15 (11\%) & 9 (14\%) & 0.7\tabularnewline
\textbf{Post-ablation Crossover} & 1 (1\%) & 1 (2\%) &
0.6\tabularnewline
\textbf{AVNRT Recurrence} & 0 & 0 & 1\tabularnewline
\bottomrule
\end{longtable}

\textbf{Figures:}

Figure 1: Representative images illustrating electroanatomic map
analysis for determination of ablation lesion proximity to His region.
Yellow balls indicate locations noted to have His electrograms. Red/Pink
balls indicate ablation lesions (4mm diameter). Green balls indicate
locations with radiofrequency ablation induced junctional ectopy. RAO =
right anterior oblique. LAO = left anterior oblique.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image1/image1}

\end{center}
\end{figure}

Figure 2: Scatter plot depicting shortest measured distance from
ablation lesion and His electrogram (His distance) by type of ablation
catheter used. Mean and standard deviation are delineated.

\textbf{Hosted file}

\verb`image2.emf`  available at \url{https://authorea.com/users/468920/articles/587324-catheter-ablation-of-atrioventricular-nodal-reentrant-tachycardia-with-an-irrigated-contact-force-sensing-radiofrequency-ablation-catheter}

\selectlanguage{english}
\FloatBarrier
\end{document}

