The best of two worlds? Pulmonary vein isolation using a novel radiofrequency ablation catheter incorporating contact force sensing technology and 56-hole porous tip irrigation

• Published in: Clinical research in cardiology Vol. 107; no. 11; pp. 1003 - 1012
• Main Authors: Maurer, Tilman, Rottner, Laura, Makimoto, Hisaki, Reissmann, Bruno, Heeger, Christian-H., Lemes, Christine, Fink, Thomas, Riedl, Johannes, Santoro, Francesco, Wohlmuth, Peter, Volkmer, Marius, Mathew, Shibu, Metzner, Andreas, Ouyang, Feifan, Kuck, Karl-Heinz, Sohns, Christian
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2018; Springer Nature B.V
• Subjects: Ablation; Arrhythmia; Blanking; Cardiology; Complications; Contact force; Feasibility studies; Fibrillation; Fluoroscopy; Intubation; Ischemia; Lavage; Medical instruments; Medical technology; Medicine; Medicine & Public Health; Original Paper; Patients; Pulmonary arteries; Radio frequency; Radiofrequency ablation; Reduction; Sensors; Tamponade; Technology; Transient ischemic attack; Contact force; Atrial fibrillation; Catheter ablation
• ISSN: 1861-0684; 1861-0692
• DOI: 10.1007/s00392-018-1270-y

Aims This study aimed to evaluate feasibility and safety as well as 1-year clinical outcome of pulmonary vein isolation (PVI) using a unique radiofrequency ablation catheter (“Thermocool SmartTouch SurroundFlow”; STSF) incorporating both, contact force (CF) sensing technology and enhanced tip irrigation with 56 holes, in one device. Methods A total of 110 patients suffering from drug-refractory atrial fibrillation underwent wide area circumferential PVI using either the STSF ablation catheter (75 consecutive patients, study group) or a CF catheter with conventional tip irrigation (“Thermocool SmartTouch”, 35 consecutive patients, control group). For each ablation lesion, a target CF of ≥ 10–39 g and a force time integral (FTI) of > 400 g s was targeted. Results Acute PVI was achieved in all patients with target CF obtained in > 85% of ablation points when using either device. Mean procedure time (131.3 ± 33.7 min in the study group vs. 133.0 ± 42.0 min in the control group; p  = 0.99), mean fluoroscopy time (14.0 ± 6 vs. 13.5 ± 6.6 min; p  = 0.56) and total ablation time were not significantly different (1751.0 ± 394.0 vs. 1604.6 ± 287.8 s; p  = 0.2). However, there was a marked reduction in total irrigation fluid delivery by 51.7% (265.52 ± 64.4 vs. 539.6 ± 118.2 ml; p  < 0.01). The Kaplan–Meier estimate 12-month arrhythmia–free survival after the index procedure following a 3-month blanking period was 79.9% (95% CI 70.4%, 90.4%) for the study group and 66.7% for the control group (95% CI 50.2%, 88.5%). This finding did not reach statistical significance ( p  = 0.18). Major complications occurred in 2/75 patients (2.7%; one pericardial tamponade and one transient ischemic attack) in the study group and no patient in the control group ( p  = 18). Conclusion PVI using the STSF catheter is safe and effective and results in beneficial 1-year clinical outcome. The improved tip irrigation leads to a significant reduction in procedural fluid burden.