title: Pulmonary vein antral isolation using an open irrigation ablation catheter for the treatment of atrial fibrillation: a randomized pilot study.
abstract: 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.
authors: Cleveland Clinic, Cleveland, Ohio.
authors: Mohamed H
authors: MH
authors: Kanj
authors: Cleveland Clinic, Cleveland, Ohio.
authors: Oussama
authors: O
authors: Wazni
authors: Cleveland Clinic, Cleveland, Ohio.
authors: Tamer
authors: T
authors: Fahmy
authors: Cleveland Clinic, Cleveland, Ohio.
authors: Sergio
authors: S
authors: Thal
authors: Cleveland Clinic, Cleveland, Ohio.
authors: Dimpi
authors: D
authors: Patel
authors: Cleveland Clinic, Cleveland, Ohio.
authors: Claude
authors: C
authors: Elayi
authors: Cleveland Clinic, Cleveland, Ohio; University of Insubria, Varese, Italy.
authors: Luigi
authors: L
authors: Di Biase
authors: Cleveland Clinic, Cleveland, Ohio.
authors: Mauricio
authors: M
authors: Arruda
authors: Cleveland Clinic, Cleveland, Ohio.
authors: Walid
authors: W
authors: Saliba
authors: Cleveland Clinic, Cleveland, Ohio.
authors: Robert A
authors: RA
authors: Schweikert
authors: Cleveland Clinic, Cleveland, Ohio.
authors: Jennifer E
authors: JE
authors: Cummings
authors: Cleveland Clinic, Cleveland, Ohio.
authors: J David
authors: JD
authors: Burkhardt
authors: Cleveland Clinic, Cleveland, Ohio.
authors: David O
authors: DO
authors: Martin
authors: Catholic University, Rome, Italy.
authors: Gemma
authors: G
authors: Pelargonio
authors: Catholic University, Rome, Italy.
authors: Antonio
authors: A
authors: Dello Russo
authors: Catholic University, Rome, Italy.
authors: Michela
authors: M
authors: Casella
authors: Catholic University, Campobasso, Italy.
authors: Pietro
authors: P
authors: Santarelli
authors: Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy.
authors: Domenico
authors: D
authors: Potenza
authors: Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy.
authors: Raffaele
authors: R
authors: Fanelli
authors: Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy.
authors: Raimondo
authors: R
authors: Massaro
authors: Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy.
authors: Giovanni
authors: G
authors: Forleo
authors: Cleveland Clinic, Cleveland, Ohio. Electronic address: natalea@ccf.org.
authors: Andrea
authors: A
authors: Natale
mesh_terms: 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