Randomized comparison between open irrigation technology and intracardiac-echo-guided energy delivery for pulmonary vein antrum isolation: procedural parameters, outcomes, and the effect on esophageal injury.
BACKGROUND
We performed a prospective study to compare efficacy and safety of both open irrigation tip (OIT) technology with intracardiac echo (ICE)-guided energy delivery in patients presenting for PVAI.


RESULTS
Fifty-three patients presenting for PVAI were randomized to ablation using an OIT catheter (Group 1, 26 patients; temperature and power were set at 50 degrees and 50 W, respectively, with a saline pump flow rate of 30 mL/min) or radiofrequency (RF) energy delivery under ICE guidance (Group 2, 27 patients; energy was titrated based on microbubbles formation). The mean procedure time and fluoroscopy exposure were lower in Group 1 (164 +/- 42 min and 7,560 +/- 2,298 microGray m2 vs 204 +/- 47 min and 12,240 +/- 4,356 microGray m2; P = 0.005 and 0.008, respectively). Moreover, the durations of RF lesions applied per PV antrum was lower in Group 1 compared with Group 2 (5.1 +/- 2.2 min vs 9.2 +/- 3.2 min, P = 0.03, respectively). Within 24 hours after PVAI in 35.7% (all erythema) of Group 1 and 57.1% (21.4% erythema and 35.7% necrosis) of Group 2, patients' esophageal wall changes were documented. After 14 +/- 2 months of follow up, recurrences were documented in 19.2% of Group 1 and 22.2% of Group 2 patients.


CONCLUSIONS
Although both OIT and ICE-guided energy delivery possess a similar effect in treating AF, OIT seems to be superior in terms of achieving isolation and shortening fluoroscopy exposure. Moreover, a lower incidence of esophageal wall injury was observed utilizing OIT for PVAI.
Marrouche
Nassir F
NF
Division of Cardiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah 84132-2400, USA. nassir.marrouche@hsc.utah.edu
Guenther
Jens
J
Segerson
Nathan M
NM
Daccarett
Marcos
M
Rittger
Harald
H
Marschang
Harald
H
Schibgilla
Volker
V
Schmidt
Martin
M
Ritscher
Guido
G
Noelker
Georg
G
Brachmann
Johannes
J
D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D004452:Echocardiography / Q000379:methods; D004935:Esophageal Diseases / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D007507:Therapeutic Irrigation / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome