Slit-based irrigation catheters can reduce procedure-related ischemic stroke in atrial fibrillation patients undergoing radiofrequency catheter ablation

• Published in: PloS one Vol. 15; no. 10; p. e0239339
• Main Authors: Kim, Yun Gi, Shim, Jaemin, Boo, Ki Yung, Kim, Do Young, Lee, Kwang-No, Choi, Jong-Il, Kim, Young-Hoon, Coppola, Giuseppe
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 01.10.2020; Public Library of Science (PLoS)
• Subjects: Ablation; Anticoagulants; Atrial fibrillation; Biology and Life Sciences; Blood clots; Cardiac arrhythmia; Care and treatment; Catheter ablation; Catheters; Causes of; Complications; Complications and side effects; Engineering and Technology; Fibrillation; Flow velocity; Irrigation; Irrigation systems; Ischemia; Laser beam cutting; Magnetic resonance imaging; Medical instruments; Medicine; Medicine and Health Sciences; Methods; Patients; Prevention; Quality of life; Radio frequency; Radiofrequency ablation; Stroke; Transient ischemic attack; South Korea; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0239339

Open irrigation ablation catheters are now the standard in radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Among various irrigation catheters, laser-cut slit-based irrigation system (Cool Flex and FlexAbility) has a unique design to cool the catheter tip more efficiently. We aimed to assess the safety of slit-based irrigation catheters regarding prevention of procedure-related ischemic complication in AF patients undergoing RFCA. The analysis was performed with Korea University Medicine Anam Hospital RFCA registry. Procedure-related ischemic complication was defined as ischemic stroke or transient ischemic attack (TIA) occurring within 30 days after RFCA. Patients were divided into 3 groups: non-irrigation, hole-based irrigation, and slit-based irrigation catheter groups. A total of 3,120 AF patients underwent first RFCA. Non-irrigation, non-slit-based irrigation, and slit-based irrigation catheters were used in 290, 1,539, and 1,291 patients, respectively. As compared with non-irrigation and non-slit-based irrigation catheter groups, slit-based irrigation catheter group had significantly older age, higher prevalence of non-paroxysmal AF, large left atrial size, and decreased left atrial appendage flow velocity. The CHA.sub.2 DS.sub.2 -VASc score was not different among the 3 groups. Procedure-related ischemic complication occurred in 17 patients (0.54%) with 16 ischemic strokes and 1 TIA event: 5/290 (1.72%), 11/1,539 (0.71%), and 1/1,291 (0.08%) events in non-irrigation, non-slit-based irrigation, and slit-based irrigation catheter groups, respectively (p = 0.001). Slit-based irrigation catheter was superior in direct comparison with non-slit-based irrigation catheter (0.71% vs. 0.08%; p = 0.009). Slit-based irrigation catheters were highly effective in preventing procedure-related ischemic complications.