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

Abstract

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.

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Citation
Maurer, T., Rottner, L., Makimoto, H. et al. Clin Res Cardiol (2018)