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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

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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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Author notes

  1. Tilman Maurer and Laura Rottner contributed equally to the manuscript.

Authors and Affiliations

  1. Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany

    Tilman Maurer, Laura Rottner, Bruno Reissmann, Christian-H. Heeger, Christine Lemes, Thomas Fink, Johannes Riedl, Francesco Santoro, Peter Wohlmuth, Shibu Mathew, Andreas Metzner, Feifan Ouyang, Karl-Heinz Kuck & Christian Sohns

  2. Department of Cardiology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany

    Hisaki Makimoto

  3. Department of Cardiology, Universitätsklinik Lübeck, Lübeck, Germany

    Christian-H. Heeger

  4. Electrophysiology Bremen, Heart Center Bremen, Klinikum Links der Weser, Bremen, Germany

    Marius Volkmer & Christian Sohns

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  1. Tilman Maurer
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Correspondence to Tilman Maurer.

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Maurer, T., Rottner, L., Makimoto, H. et al. 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. Clin Res Cardiol 107, 1003–1012 (2018). https://doi.org/10.1007/s00392-018-1270-y

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