Pulmonary vein antral isolation using an open irrigation ablation catheter for the treatment of atrial fibrillation: a randomized pilot study.
OBJECTIVE
We sought to test how catheter ablation using an open irrigation catheter (OIC) compares with standard catheters for pulmonary vein antrum isolation.


BACKGROUND
Open irrigation catheters have the advantage of delivering greater power without increasing the temperature of the catheter tip, which enables deeper and wider lesions without the formation of coagulum on catheters.


METHODS
Catheter ablation was performed using an 8-mm catheter (8MC) or an OIC. Patients were randomized to 3 groups: 8MC; OIC-1, OIC with a higher peak power (50 W); and OIC-2, OIC with lower peak power (35 W).


RESULTS
A total of 180 patients were randomized to the 3 treatment strategies. Isolation of pulmonary vein antra was achieved in all patients. The freedom from atrial fibrillation was significantly greater in the 8MC and OIC-1 groups compared with the OIC-2 group (78%, 82%, and 68%, respectively, p = 0.043). Fluoroscopy time was lower in OIC-1 compared with OIC-2 and 8MC (28 +/- 1 min, 53 +/- 2 min, and 46 +/- 2 min, respectively, p = 0.001). The mean left atrium instrumentation time was lower in the OIC-1 compared with the OIC-2 and 8MC groups (59 +/- 3 min, 90 +/- 5 min, and 88 +/- 4 min, respectively, p = 0.001). However, there was a greater incidence of "pops" in the OIC-1 (100%, 0%, 0%, p < 0.001) along with higher incidences of pericardial effusion (20%, 0%, 0%, p < 0.001) and gastrointestinal complaints (17% in OIC-1, 3% in 8MC, and 5% in OIC-2, p = 0.031).


CONCLUSIONS
Although there was a decrease in fluoroscopy and left atrium instrumentation time with the use of OIC at higher power, this setting was associated with increased cardiovascular and gastrointestinal complications.
Kanj
Mohamed H
MH
Cleveland Clinic, Cleveland, Ohio.
Wazni
Oussama
O
Cleveland Clinic, Cleveland, Ohio.
Fahmy
Tamer
T
Cleveland Clinic, Cleveland, Ohio.
Thal
Sergio
S
Cleveland Clinic, Cleveland, Ohio.
Patel
Dimpi
D
Cleveland Clinic, Cleveland, Ohio.
Elayi
Claude
C
Cleveland Clinic, Cleveland, Ohio.
Di Biase
Luigi
L
Cleveland Clinic, Cleveland, Ohio; University of Insubria, Varese, Italy.
Arruda
Mauricio
M
Cleveland Clinic, Cleveland, Ohio.
Saliba
Walid
W
Cleveland Clinic, Cleveland, Ohio.
Schweikert
Robert A
RA
Cleveland Clinic, Cleveland, Ohio.
Cummings
Jennifer E
JE
Cleveland Clinic, Cleveland, Ohio.
Burkhardt
J David
JD
Cleveland Clinic, Cleveland, Ohio.
Martin
David O
DO
Cleveland Clinic, Cleveland, Ohio.
Pelargonio
Gemma
G
Catholic University, Rome, Italy.
Dello Russo
Antonio
A
Catholic University, Rome, Italy.
Casella
Michela
M
Catholic University, Rome, Italy.
Santarelli
Pietro
P
Catholic University, Campobasso, Italy.
Potenza
Domenico
D
Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy.
Fanelli
Raffaele
R
Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy.
Massaro
Raimondo
R
Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy.
Forleo
Giovanni
G
Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy.
Natale
Andrea
A
Cleveland Clinic, Cleveland, Ohio. Electronic address: natalea@ccf.org.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011182:Postoperative Care / Q000379:methods; D011336:Probability; D011667:Pulmonary Veins / Q000601:surgery*; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D007507:Therapeutic Irrigation / Q000295:instrumentation; D013997:Time Factors; D016896:Treatment Outcome