Porous Tip Research Articles

In-line RNA-based microreactor direct mass spectrometry for ultrasensitive and rapid assay of terminal deoxynucleotidyl transferase activity

Terminal deoxynucleotidyl transferase (TdT), a unique template-independent DNA polymerase, plays a crucial role in the human adaptive immune system and is considered a promising biomarker for the diagnosis of various forms of acute or chronic leukemia. The accurate and sensitive detection of trace TdT is of pivotal importance to fulfill the significant medical interest in understanding its pathological functions and diagnosing TdT-related diseases. We hereby present an in-line RNA-based microreactor direct mass spectrometry (MS) method and its application for ultrasensitive, accurate, and rapid analysis of trace TdT activity in leukemic cell samples. A specially designed RNA-based microreactor is fabricated by immobilizing short RNA sequence via covalent Au–S bond on the inner surface of a capillary pre-modified with three-dimensional porous layer (PL) and Au nanoparticles (AuNPs). Utilizing this PL@Au@RNA microreactor, the signal of target TdT is conversed into reporter molecules (adenine), which exhibit a strong MS response. This conversion process enables efficient signal amplification and enhances detection sensitivity. The outlet end of the PL@Au@RNA microreactor is deliberately crafted into a porous tip, serving as an electrospray ionization (ESI) interface to directly couple to ESI-MS in-line. This design facilitates the direct transmission of the generated signaling molecules into the MS system, eliminating the need for laborious sample treatment procedures. By implementing this RNA-based microreactor in direct MS analysis, we have achieved remarkable sensitivity in detecting TdT activity with the limit-of-detection of 4 × 10−9 U, surpassing other reported methods in literature by three to four orders of magnitude. Furthermore, each assay requires a minimal sample volume of merely 10 nL. This method has successfully demonstrated its application in accurately and efficiently detecting TdT activity in leukemia cells, and its detection results are consistent with those obtained by ELISA kits.

Numerical study of porous tip treatment in suppressing tip clearance vortices in cavitating flow

Tip clearance cavitation (TCC) is a type of vortex cavitation. It widely exists in axial flow hydraulic machinery and has significant negative influence on the mechanical service life and the operating stability. It is necessary to suppress the tip clearance vortices (TCV) to control the TCC in engineering applications. Based on the analysis of the advantages and disadvantages of the present various suppression strategies, a new coupling method is proposed in this study by combining the damping approach and the diversion approach. Porous medium material is used to realize the coupling effect. A 2 mm span length porous tip is installed on the solid tip surface of a hydrofoil under two gap sizes conditions (representing two types of gap flow pattern), and excellent suppression results of the TCV and TCC are obtained. The characteristics and mechanism of the clearance flow are analyzed by numerical simulation. The numerical accuracy is verified by experimental qualitative observations. The simulation results show that the temporal and spatial stability of the clearance flow field is enhanced, and the leakage velocity and the TCV strength are weakened via the combined action of damping and diversion effects. There is a difference in the damping mechanism between the two gap flow patterns. It is a comprehensive result of viscous dissipation and momentum loss in the jet pattern represented by the small gap size, and primarily, the result of momentum loss in the rolling pattern represented by the large gap size.

Capillary electrophoresis-mass spectrometry for creatinine analysis in residual clinical plasma samples and comparison with gold standard assay.

When hospitalized, infants, particularly preterm, are often subjected to multiple painful needle procedures to collect sufficient blood for metabolic screening or diagnostic purposes using standard clinical tests. For example, at least 100µL of whole blood is required to perform one creatinine plasma measurement with enzymatic colorimetric assays. As capillary electrophoresis-mass spectrometry (CE-MS) utilizing a sheathless porous tip interface only requires limited amounts of sample for in-depth metabolic profiling studies, the aim of this work was to assess the utility of this method for the determination of creatinine in low amounts of plasma using residual blood samples from adults and infants. By using a starting amount of 5µL of plasma and an injection volume of only 6.7nL, a detection limit (S/N=3) of 30nM could be obtained for creatinine, and intra- and interday precisions (for peak area ratios) were below 3.2%. To shorten the electrophoretic separation time, a multi-segment injection (MSI) strategy was employed to analyze up to seven samples in one electrophoretic run. The findings obtained by CE-MS for creatinine in pretreated plasma were compared with the values acquired by an enzymatic colorimetric assay typically used in clinical laboratories for this purpose. The comparison revealed that CE-MS could be used in a reliable way for the determination of creatinine in residual plasma samples from infants and adults. Nevertheless, to underscore the clinical efficacy of this method, a subsequent investigation employing an expanded pool of plasma samples is imperative. This will not only enhance the method's diagnostic utility but also contribute to minimizing both the amount and frequency of blood collection required for diagnostic purposes.

Porous tip radiofrequency ablation catheter reduced heart failure-related complications and healthcare resource utilization in paroxysmal atrial fibrillation patients.

A 56-hole porous tip radiofrequency catheter was developed to provide more uniform cooling with less fluid delivery than a prior 6-hole irrigated design. This study aimed to evaluate the impact of contact force (CF) ablation with the porous tip on complications (congestive heart failure [CHF] and non-CHF related), healthcare resource utilization, and procedural efficiency in patients undergoing de novo paroxysmal atrial fibrillation (PAF) ablations in a real-world setting. Consecutive de novo PAF ablations were performed between February 2014 and March 2019 by six operators at a single US academic center. The 6-hole design was used through December 2016 with the 56-hole porous tip adopted in October 2016. The outcomes of interest included symptomatic CHF presentation and CHF-related complications. Of 174 patients who were included, mean age was 61.1± 10.8 years, 67.8% were male, and 25.3% had a history of CHF. Ablation with the porous tip catheter significantly decreased fluid delivery (1177 vs. 1912 mL with the 6-hole design; p< .0001). CHF-related complications within 7 days, particularly fluid overload, were substantially reduced with the porous tip (15.2% vs. 5.3% of patients; p =.0281) and the proportion of patients with symptomatic CHF presentation within 30 days postablation was significantly lower (14.7% vs. 32.5%; p =.0058). The 56-hole porous tip led to significantly reduced CHF-related complications and healthcare utilization in PAF patients undergoing CF catheter ablation when compared to the prior 6-hole design. This reduction likely results from the significant decrease in fluid delivery during the procedure.

Aptamer affinity-based microextraction in-line coupled to capillary electrophoresis mass spectrometry using a porous layer/nanoparticle -modified open tubular column

An aptamer affinity based microextraction column is developed to be directly in-line coupled to capillary electrophoresis-mass spectrometry (CE-MS) for analyzing mycotoxins in food samples. Single-stranded DNA aptamers for selective recognition of aflatoxin B1 (AFB1) and ochratoxin A (OTA) targets are co-immobilized via covalent bonds on the surface of the inlet end of a capillary, which is pre-modified with three-dimensional porous layer and gold nanoparticles to enhance the specific surface area and loading capacity. The outlet of the capillary is designed as a porous tip to serve as the spray source for injection to the mass spectrometry. All the necessary processes for pretreatment and analysis of a sample are accomplished in one injection, including aptamer affinity-based microextraction, CE separation and MS detection of analytes. AFB1 and OTA are simultaneously determined in a wide linear range with sample consumption of only 1 μL and the limit-of-detection as low as 1 pg/mL. The microextraction column exhibits excellent repeatability and stability, which can be used over 45 runs within a month with CE separation efficiency and only MS intensity slightly decreased. Mycotoxins in three kinds of cereal based infant foods are accurately analyzed using the proposed method. The study provides a robust and universal approach that would have potential applications in a variety of analytical fields based on selective molecular recognition coupling to CE-MS analysis.

Tip-porous microneedle: A highly stable sensing platform for direct determination of labile metals in natural seawater

Nanomaterial-functionalized voltammetric microsensors are promising tools for detecting trace metals at low concentrations in the complex environment of natural seawater. However, the sensitivity reduction caused by the loss of modified nanomaterials in the detection process has always been a major problem. Herein, to fabricate a highly stable sensing platform, a microneedle electrode with a hierarchical porous tip was prepared through electrochemical etching technology to firmly embed nanoparticles. Using copper (Cu) as a model trace metal, a micro-cluster needle sensor based on a gold nanoparticle (AuNP)-embedded tip-porous microneedle electrode (P-MNE) was fabricated for the direct voltammetric determination of labile Cu in natural seawater. The porous structure of P-MNE not only provided a larger specific surface area and active sites for AuNPs which had excellent electrocatalytic performance for Cu2+ determination, but also protected from their loss during the detection process in seawater. Therefore, this novel micro-cluster needle sensor exhibited significantly improved stability with a relative standard deviation (RSD) of 1.5% for 30 detections. The linear range of Cu2+ on this micro-cluster needle sensor was from 0.1 to 1000 nM with a detection limit of 0.03 nM. More importantly, this micro-cluster needle sensor was successfully used for directly detecting labile Cu in natural seawater samples without any preaccumulation treatment or reagent addition to obtain the contribution proportions of the labile fraction in total dissolved Cu. Furthermore, this sensing platform might also be extended to the reliable determination of other labile metals in seawater by changing the functional nanoparticles embedded in the nanopores.

Catheter ablation using advanced porous tip contact force-sensing radiofrequency catheter: Impact on health care utilization among patients with persistent atrial fibrillation.

Catheter ablation (CA) is an effective treatment for patients with persistent atrial fibrillation (PsAF); however, little is known about its impact on health care utilization for patients with PsAF. The ThermoCool SmartTouch SF (STSF) catheter (Biosense Webster) incorporates an advanced porous tip and contact force-sensing technology. The purpose of this study was to determine health care utilization among patients with PsAF who underwent ablation with the STSF catheter. A retrospective cohort study using the Premier Healthcare Database identified patients with PsAF undergoing CA with the STSF catheter in inpatient and outpatient settings. The proportion of patients experiencing AF-related inpatient admissions, outpatient admissions, emergency department (ED) visits, electrical cardioversion, and a composite outcome in the 12 months pre- vs postablation were compared using the McNemar test. Subanalyses were performed on study outcomes by race/ethnicity. The final sample included 3077 patients (mean age 65.9 years; 31.7% female). Among patients with PsAF undergoing ablation with the STSF catheter, relative reductions in health care utilization in the 12 months post- vs preablation included 55.3% in AF-related inpatient admissions (P <.0001), 38.9% in outpatient admissions (P <.0001), 52.4% in ED visits (P <.0001), and 61.2% in electrical cardioversions (P <.0001). Composite outcomeutilization in the 12 months post- vs preablation declined by 40.2% (P <.0001) for the overall cohort, 40.0% for White patients (P <.0001), 52.2% for Black patients (P <.0001), and 50.1% for Asian patients (P = .032). Significant improvements in health care utilization were observed among PsAF patients who underwent ablation using the STSF catheter. Improvements were particularly marked in underrepresented racial and ethnic groups.

Steerable sheath visualizable under 3D electroanatomical mapping facilitates paroxysmal atrial fibrillation ablation with minimal fluoroscopy

BackgroundAdvances in technology and workflows have facilitated substantial reductions in fluoroscopy utilization and procedure times for atrial fibrillation (AF) ablations. A recently available steerable sheath, visualizable on a 3D electroanatomical map (EAM), may further simplify low/zero fluoroscopy ablation workflows by facilitating understanding of the relative positions of the catheter and sheath. The objective of this study was to demonstrate feasibility, safety, procedural efficiency, and clinical effectiveness of incorporating the new visualizable sheath into a low-fluoroscopy workflow.MethodsConsecutive de novo paroxysmal AF procedures were performed with a porous tip contact force catheter at a high-volume site between January 2018 and May 2019. Procedures performed with and without the VIZIGO™ EAM-visualizable sheath (Vizigo) were compared. All ablations employed the same standardized low-fluoroscopy workflow. Statistical analyses employed stabilized inverse probability of treatment weights (IPTW) to balance cohorts by operator and key patient characteristics.ResultsCohorts of 142 Vizigo and 173 non-Vizigo patients were similar at baseline. Use of the Vizigo sheath was associated with approximately 10% improvement in catheter stability (p = 0.0005), 16% reduction in radiofrequency time (p < 0.0001), and 7% fewer ablations that used fluoroscopy (p = 0.0030). There was one cardiac tamponade in each cohort and no deaths, atrioesophageal fistulas, or strokes. Single-procedure freedom from atrial arrhythmia recurrence through 12 months was similar between cohorts (p = 0.9556).ConclusionsUse of a 3D EAM-visualizable sheath resulted in improved catheter stability, reduced radiofrequency time, and more procedures performed without fluoroscopy, without compromise to safety or effectiveness.

Protocol for Etching Bare-Fused Silica Capillaries for Sheathless Capillary Electrophoresis-Mass Spectrometry Coupling.

Homemade capillaries are a very common practice for the users of capillary electrophoresis (CE), notably in CE-UV. With the advent of the capillary electrophoresis-mass spectrometry coupling since the end of the 1980s, several interfaces have been developed. Among those interfaces, the porous tip sprayer allows great sensitivity at nano flow rates and has been used in numerous applications over the past few years. However, the homemade implementation of a suitable capillary for the porous tip sprayer is more challenging. The porous tip is created by etching the bare-fused silica capillary with hydrofluoric acid. Here we describe the complete process of etching bare-fused silica capillaries, from length cutting to quality control of the newly etched capillary.

Assessing the Energy Status of Low Numbers of Mammalian Cells by Capillary Electrophoresis-Mass Spectrometry.

Capillary electrophoresis-mass spectrometry (CE-MS) employing a sheathless porous tip interface has become a strong analytical tool for the efficient profiling of highly polar and charged metabolites in volume/material-restricted biological samples. As more and more metabolomics studies are (intrinsically) dealing with low numbers of mammalian cells, it would be important to use an additional performance metric to effectively evaluate the sampling and sample preparation procedure, in particular quenching. An established parameter to assess the sampling and sample preparation quality when working with cell cultures is the adenylate energy charge (AEC), which represents an index of the energy state of a cell. In this protocol, a CE-MS strategy is proposed for the reliable determination of the adenylate energy charge (AEC) in metabolomics studies dealing with low numbers of mammalian cells.

Влияние пористых законцовок крыла на формирование концевых вихрей

The interaction of a wingtip made of a porous material with a tip vortex has been studied. It has been established that the porous tip significantly affects the structure and parameters of the vortex and reduces its intensity.

Abstract 12387: Porous Tip Radiofrequency Ablation Catheter Reduced Heart Failure Related Complications and Healthcare Utilization in Paroxysmal Atrial Fibrillation Patients

Introduction: Efforts to improve the safety of catheter ablation procedures have led to continuous improvements in catheter design. A 56-hole porous tip contact force (CF) catheter was developed to provide more uniform cooling with less fluid delivery than a prior 6-hole irrigated design, a change intended to reduce fluid overload and associated complications related to congestive heart failure (CHF). Hypothesis: We hypothesized that ablations using a 56-hole porous tip CF catheter would lead to reductions in CHF-related complications and healthcare utilization, compared to the prior 6-hole design. Methods: Consecutive de novo paroxysmal atrial fibrillation (PAF) ablations were performed between 2/14 - 3/19 by six operators at a single academic center. The 6-hole design was used through 12/16 with the 56-hole porous tip adopted in 10/16. Patient characteristics, procedural detail, and CHF-related complications or symptomatic presentation through 30 days were collected from electronic health records, as defined in table. Results: The population included 174 patients, age 61.1 ± 10.8 years, 67.8% male, with 25.3% having a history of CHF. Compared to the 6-hole design, the 56-hole catheter significantly reduced composite CHF-related complications within 7 days and CHF-related healthcare utilization within 30 days. In contrast to CHF reductions, non-CHF complications within 7 days were not different. Conclusion: In a real-world setting, a 56-hole porous tip irrigated CF catheter significantly reduced CHF-related complications and healthcare utilization in PAF patients when compared to the prior 6-hole design. This reduction may be related to the significant reduction in fluid delivery during the procedure. See table on next page.

Predictors of clinical success after paroxysmal atrial fibrillation catheter ablation

Contact force (CF) guided ablation of paroxysmal atrial fibrillation (PAF) with stable catheter-tissue contact optimizes clinical success and may increase an operator's ability to achieve pulmonary vein isolation (PVI) in a single encirclement. First pass PVI reduces procedure time but the relationship with long term clinical success is not well understood. This study evaluated patient characteristics and procedural details as predictors of 1-year clinical success after PAF ablation, including first pass isolation. Consecutive de novo PAF ablations were performed with a porous tip CF catheter in 2017 and 2018. All ablations used wide-area circumferential ablation, with first pass isolation captured separately for the left and right pulmonary veins (PVs). CF was held between 10 and 20 g and the catheter was moved every 10-20 s. Radiofrequency energy was set at 40-45 W throughout the atrium. Patient characteristics and procedural details were tested for association with clinical success, defined as freedom from recurrent atrial tachyarrhythmia through 1 year. A total of 404 patients were included in the study. Clinical success at 1 year was 86.6%. Achieving first pass isolation on at least one ipsilateral PV pair was the most significant predictor of clinical success (p = .0126). After controlling for first pass isolation, only recurrence within the 90-day blanking period was independently predictive (p = .0015). First pass isolation was not associated with early recurrence (p = .2454). In a real-world setting, first pass isolation was highly predictive of 12-month clinical success after CF-guided ablation in a PAF population.

Rupture of Liquid Bridges on Porous Tips: Competing Mechanisms of Spontaneous Imbibition and Stretching.

Liquid bridges are commonly encountered in nature and the liquid transfer induced by their rupture is widely used in various industrial applications. In this work, with the focus on the porous tip, we studied the impacts of capillary effects on the liquid transfer induced by the rupture through numerical simulations. To depict the capillary effects of a porous tip, a time scale ratio, RT, is proposed to compare the competing mechanisms of spontaneous imbibition and external drag. In terms of RT, we then develop a theoretical model for estimating the liquid retention ratio considering the geometry, porosity, and wettability of tips. The mechanism presented in this work provides a possible approach to control the liquid transfer with better accuracy in microfluidics or microfabrications.

First pass isolation predicts clinical success after contact force guided paroxysmal atrial fibrillation ablation

Abstract Background Contact force (CF) ablation of AF with a focus on catheter-tissue contact stability optimizes clinical success and may help the operator to achieve pulmonary vein (PV) isolation in a single encirclement. While it seems evident that first pass isolation reduces procedure time, the effect on long term clinical success has not been reported. Purpose To evaluate the relationship between first pass isolation and freedom from atrial tachyarrhythmia recurrence at 1 year after PAF ablation. Methods Consecutive de novo PAF ablations were performed with a porous tip contact force catheter in 2017. All ablations used wide-area circumferential ablation and first pass isolation was captured separately for the left and right PVs. CF was held between 10–20 g and the catheter was moved every 10–20 s. RF energy was set at 40W throughout the atrium. Clinical success was defined as freedom from recurrent atrial tachyarrhythmia through 1 year following a 90-day blanking period and freedom from reablation at any time through 1 year. Results The population included 157 patients, age 62.7±11.5, 54.8% male, with mean CHA2DS2-VASc score of 2.3±1.5. Mean procedure times were 76.2±29.8 minutes and 89.2% of the ablations were performed with no fluoroscopy. The overall clinical success rate at 1 year was 86.1%. The number of ipsilateral PV pairs that could be isolated in a single pass was significantly associated with 1-year success (p=0.0043). Achieving first pass isolation on even one ipsilateral PV pair vs. neither pair was significantly associated with clinical success (Table). Conclusion In a real-world setting, first pass isolation on at least one PV side was predictive of 1 year clinical success in a PAF population ablated with CF. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Biosense Webster, Inc.

The use of a high-power (50W), ablation index-guided protocol for ablation of the cavotricuspid isthmus.

BackgroundHigh‐power (HP) ablation protocols are increasingly used for ablation procedures to shorten procedural times and improve short‐ and long‐term success. The ablation index (AI) combines contact force, power settings, and ablation time. It can be used in combination with HP protocols to guide operators toward standardized lesions. The purpose of this study was to evaluate both a HP and AI‐guided strategy for ablation of the cavotricuspid isthmus (CTI) in patients with typical atrial flutter (AFL).MethodsIn this single‐center study, consecutive patients with typical AFL (n = 52, mean age 68.7 ± 8.3 years, 21/52 [40.4%] female) underwent AI‐guided HP radiofrequency (RF) ablation of the CTI. Ablation was performed with 50 W and AI target values of 550 with a maximum ablation duration of 25 seconds per lesion. Target interlesion distance was ≤6 mm. Ablation was performed with a 3.5 mm porous tip Smarttouch SF catheter.ResultsAcute CTI block was achieved in 52 of 52 patients (100%), and first‐pass conduction block was achieved in 41 of 52 patients (80.4%). Spontaneous reconduction after 30 minutes waiting time occurred in 1 of 52 (1.9%) patient. Average ablation time until CTI block was 3:51 ± 1:40; 2:33 ± 1:01 minutes of bonus ablation pulses were applied after CTI block. An audible steam pop was noted in one patient (1.9%). No major complications occurred. After a mean follow‐up of 193.7 ± 152.2 days, no patient showed recurrence of typical AFL.ConclusionIn this pilot study, AI‐guided HP ablation of the CTI was fast, safe, and effective.

Real-world outcomes comparison among adults with atrial fibrillation undergoing catheter ablation with a contact force porous tip catheter versus a second-generation cryoballoon catheter: a retrospective analysis of multihospital US database

ObjectiveTo compare real-world clinical and economic outcomes among atrial fibrillation (AF) patients undergoing cardiac ablation with the contact force-sensing porous tip THERMOCOOL SMARTTOUCH SF (STSF) catheter versus the Arctic Front...

Persistent Atrial Fibrillation Ablation With Contact Force-Sensing Catheter: TheProspectiveMulticenter PRECEPT Trial.

This study sought to evaluate the safety and effectiveness of catheter ablation of persistent atrial fibrillation (PsAF) using a porous tip contact force-sensing catheter. Although the safety and effectiveness of catheter ablation of paroxysmal atrial fibrillation are established, there are limited data on outcomes in patients with PsAF. As such, no ablation catheter is currently approved by the Food and Drug Administration for PsAF ablation. The prospective, multicenter, nonrandomized PRECEPT (Prospective Review of the Safety and Effectiveness of the THERMOCOOL SMARTTOUCH SF Catheter Evaluated for Treating Symptomatic PersistenT AF) study was conducted at 27 sites in the United States and Canada. Enrollment criteria included documented symptomatic PsAF and nonresponse or intolerance to≥1 antiarrhythmic drug (Class I or III). An individualized treatment approach was used including pulmonary vein isolation with ablation of additional targets permitted at the investigators' discretion. To optimize treatment outcomes, a 3-month post-ablation medication adjustment period followed by a 3-month therapy consolidation period were included. Arrhythmia recurrences were stringently monitored by monthly and symptomatic transtelephonic monitoring, electrocardiography, and Holter monitoring for up to 15months after ablation. Of 381 enrolled participants, 348 had the investigational catheter inserted and underwent ablation. The primary adverse event rate was 4.1% (15 events in 14 participants). Kaplan-Meier analyses estimated a primary effectiveness success rate of 61.7% and a clinical success rate of 80.4% at 15months. The results demonstrate the clinical safety and effectiveness of PsAF ablation using contact force-sensing technologies. The primary adverse event was within the expected range and similar to those reported in historical studies of paroxysmal AF ablation. (Prospective Review of the Safety and Effectiveness of the THERMOCOOL SMARTTOUCH SF Catheter Evaluated for Treating Symptomatic PersistenT AF; NCT02817776).

Long-term safety and effectiveness of paroxysmal atrial fibrillation ablation using a porous tip contact force-sensing catheter from the SMART SF trial

PurposeThe prospective, multicenter SMART SF trial demonstrated the acute safety and effectiveness of the 56-hole porous tip irrigated contact force (CF) catheter for drug-refractory paroxysmal atrial fibrillation (PAF) ablation with a low primary adverse event rate (2.5%), leading to FDA approval of the catheter. Here, we are reporting the long-term effectiveness and safety results that have not yet been reported.MethodsAblations were performed using the 56-hole porous tip irrigated CF catheter guided by the 3D mapping system stability module. The primary effectiveness endpoint was freedom from atrial tachyarrhythmia (including atrial fibrillation, atrial tachycardia, and/or atrial flutter), based on electrocardiographic data at 12 months. Atrial tachyarrhythmia recurrence occurring 3 months post procedure, acute procedural failures such as lack of entrance block confirmation of all PVs, and undergoing repeat procedure for atrial fibrillation in the evaluation period (91 to 365 days post the initial ablation procedure) were considered to be effectiveness failures.ResultsSeventy-eight patients (age 64.8 ± 9.7 years; male 52.6%; Caucasian 96.2%) participated in the 12-month effectiveness evaluation. Mean follow-up time was 373.5 ± 45.4 days. The Kaplan-Meier estimate of freedom from 12-month atrial tachyarrhythmia was 74.9%. Two procedure-related pericardial effusion events were reported at 92 and 180 days post procedure. There were no pulmonary vein stenosis complications or deaths reported through the 12-month follow-up period.ConclusionsThe SMART SF 12-month follow-up evaluation corroborates the early safety and effectiveness success previously reported for PAF ablation with STSF.

P2835Feasibility and safety of same day discharge after radiofrequency catheter ablation for paroxysmal atrial fibrillation

Abstract Background Atrial fibrillation catheter ablation (CA) is the most frequent arrhythmia ablation and accounts for a significant proportion of treatment cost. Same day discharge (SDD) after paroxysmal atrial fibrillation (PAF) ablation is an attractive strategy for both patients and hospitals. Objective To understand the eligibility criteria and outcomes for PAF patients who can safely undergo same day discharge after radiofrequency catheter ablation. Methods Patients undergoing CA for PAF were evaluated for SDD at a pre-procedure visit to assess the risk of groin, respiratory, cardiac or bleeding complications. Eligibility criteria for SDD were stable anticoagulation and absence of bleeding history, systolic/diastolic heart failure, or interventional procedures within 60 days, with recommended BMI &lt;35. Patient proximity to the hospital was also considered. Anesthesia included propofol with endotracheal intubation and all patients were ablated with a porous tip contact force catheter (STSF). Patients were on bed rest for 6 hours post-procedure, then ambulated intermittently for 1–2 hours. Discharge followed if they were stable with no evidence of vascular access complications or bleeding. A dedicated RN telephoned patients the following morning to ask a series of standard questions designed to elicit evidence of any complications. Results 52 procedures were identified for SDD, with 7 patients declining. 45 planned SDD procedures for 43 patients occurred 4/17–6/18. Average age was 57±11 years and CHA2DS2-VASc was 1.5±1.1 at procedure. Procedure time was 69±26 min (IQR: 49 - 84 min) with maximum fluoroscopy usage of 0.2 min and 508±149 mL of fluid infused through the catheter. Two patients stayed overnight due a groin bleed and atelectasis with fever, and one chose to stay for comfort. The remaining 42 discharges occurred after 7.2±1.0 hours in recovery, with no SDD-related complications and no required return visits after the follow-up call. There were 3 AF recurrences (6.7%) as of the 10 week visit. Conclusion Appropriate low risk patients identified by simple clinical criteria can be safely discharged the same day after CA of PAF. Further evaluation is required for higher risk patients. Acknowledgement/Funding The study was funded by Biosense Webster Inc.