Those are all optional tools dependent patient characteristics and procedure type. Contact force catheters helps mostly with fellows coming up on learning curve. In the most experienced centers, CF does no better than SF, actually slightly worse in AF and significantly worse in VT. Probably because both commercial versions are relatively stiff. And oblique angle error in contact force is an issue. Still the additional data over conventional manual is nice. However, using force to establish stability can result in false signals so mapping is still left to specialised catheters, when precision is required, that have different biophysics than the ablation catheter that tries to get to the same spot for substrate ablation. All those complexities are the reasons that cryoballoon is taking big bites of market share especially at lower volume centers even at unacceptably high risk of phrenic nerve palsy. The buyouts of Topera, Cardio Insight, Ablation Frontiers, etc .... has made a lot of EPs wealthy for technology that is still to be proven. Biosig like others seems to be a vehicle for some to get on that gravy train. At least is not HIFU or laser balloon where unwitting human guinea pigs are put on the line.
