Clinical experience with contact-force and flexible-tip ablation catheter designs

• Published in: Journal of interventional cardiac electrophysiology 2016-10, Vol.47 (1), p.75-82
• Main Authors: Deubner, N., Greiss, H., Akkaya, E., Berkowitsch, A., Zaltsberg, S., Hamm, C. W., Kuniss, M., Neumann, T.
• Format: Article
• Language: English
• Subjects: Aged; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Atrial Fibrillation - surgery; Cardiology; Catheter Ablation - instrumentation; Catheter Ablation - methods; Catheter Ablation - statistics & numerical data; Disease-Free Survival; Elastic Modulus; Equipment Design; Equipment Failure Analysis; Female; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Monitoring, Intraoperative - instrumentation; Monitoring, Intraoperative - methods; Monitoring, Intraoperative - statistics & numerical data; Prevalence; Recurrence; Reproducibility of Results; Sensitivity and Specificity; Stress, Mechanical; Treatment Outcome
• ISSN: 1383-875X; 1572-8595
• DOI: 10.1007/s10840-016-0128-3

Purpose Lesion formation is a critical determinant of technical and clinical success of pulmonary vein isolation. Different catheter designs aim to enhance tissue contact during ablation to enable optimized lesion formation. We analyzed procedural characteristics and predictors of clinical success in patients ablated with three different contemporary ablation catheters. Methods Two hundred sixty-eight sequentially included patients receiving pulmonary vein isolation (PVI) with conventional ( n  = 122), contact-force ( n  = 96) and flexible-tip ( n  = 60) catheters were followed for a median of 14.1 months with 7d-Holter-monitoring and TTE at 3, 6, 12, and 24 months. Baseline characteristics and follow-up times were homogeneous across all groups. Results Multivariable Cox proportional hazard regression for arrhythmia recurrence demonstrated a favorable hazard ratio for contact-force and flexible-tip catheters vs. conventional open irrigation catheters. Procedure time and fluoroscopy time were shorter for contact-force and flexible-tip catheters versus conventional catheters, but equal between. Linear lesions were applied in 58 % of contact-force and 66 % of flexible-tip cases, and CFAEs were targeted in 26 % of either. Conclusions Our non-randomized prospectively collected data do not show a difference in observed procedure characteristics and in clinical outcome for flexible-tip versus contact-force catheter designs, while both display improved performance against conventional open irrigated-tip catheters. Linear lesions and CFAEs ablation were not associated with improved arrhythmia-free survival.