Porous tip contact force-sensing catheters for pulmonary vein isolation: performance in a clinical routine setting.

Abstract

In catheter ablation of atrial fibrillation (AF), contact force (CF)-sensing catheters with an irrigated tip are used to deliver radiofrequency (RF) energy to the tissue. The ThermoCool® Smarttouch™ Surroundflow catheter (STSF) integrates CF-sensing technology and a new porous tip for advanced external cooling. The aim was to evaluate the performance and safety of STSF in a clinical setting of pulmonary vein isolation (PVI) in comparison with standard contact force-sensing catheter (ST). We assigned consecutive patients (n = 80, prospectively, open-label, non-randomized) with symptomatic AF to either PVI with STSF (n = 60) or ST (n = 20). Total ablation time to achieve PVI was significantly shorter in STSF compared to that in ST (STSF, 1556 ± 435s vs. ST, 1922 ± 961s; p = 0.045). Ablation time to achieve loss of pace capture of left pulmonary veins was shorter using STSF (left veins, 155 ± 140s vs. 291 ± 188s; p = 0.01; right veins, 208 ± 196s vs. 369 ± 306s; p = 0.09). Furthermore, administered irrigation fluid was significantly reduced in STSF (241.4 ± 79.6ml vs. 540.3 ± 229.5ml; p < 0.01). CF was lower during ablation of left pulmonary veins. One steam pop occurred in STSF, which did not lead to pericardial effusion (vs. no steam pop in ST). The Kaplan-Meier estimate 12-month AF recurrence was 34.3% and 37.7% (p = 0.8). Integrating CF technology and the porous tip technology enables effective energy transfer to the tissue resulting in shorter ablation time and less irrigation fluid administration. In our cohort, PVI using the STSF was not associated with an increased complication rate or AF recurrence rate after 12-month follow-up when compared with the ST.