title: Comparison of cooled-tip versus 4-mm-tip catheter in the efficacy of acute ablative tissue injury during circumferential pulmonary vein isolation.
abstract: BACKGROUND
  Although several studies have reported the benefits of cooled-tip ablation for circumferential pulmonary veins isolation (CPVI), the acute change of substrate property and acute PV reconnection have not been well demonstrated. The aim of this study was to compare the cooled-tip with regular 4-mm-tip catheter in acute substrate change after CPVI and long-term efficacy.
  
  
  RESULTS
  One hundred and fifty-six patients (115 males, age 53 +/- 12 years) who underwent CPVI for treatment of atrial fibrillation (AF) were included. Group A consisted of 52 patients with cooled-tip ablation, and group B consisted of 104 patients with 4-mm-tip catheter ablation. The bipolar voltage of circumferential lesions was obtained using a 3-dimensional (3D) mapping system (NavX) before and after CPVI. The electrical reconnections of 4 PVs were evaluated 30 minutes after CPVI using a circular catheter. Cooled-tip catheter caused more reduction of the electrical voltage in PV antrum, lower incidence of acute PV reconnection, inducibility of AF, and gap-related atrial tachyarrhythmia (AT). Less number of left atrial (LA) ablation line and ablation applications and less procedure time were found in cooled-tip group compared to 4-mm-tip group. No significant difference in the incidence of pain sensation and complication was observed between the 2 groups. At a 14-month follow-up, the recurrence rate in the cooled-tip group was lower than in the 4-mm group (13.5% vs 33.7%, P = 0.009).
  
  
  CONCLUSIONS
  Cooled-tip catheter has a superior long-term outcome than the 4-mm-tip catheter in CPVI, which may be associated with the efficacy of transmural block and electrical isolation in PV antrum.
authors: Department of Medicine and Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors: Shih-Lin
authors: SL
authors: Chang
authors: Ching-Tai
authors: CT
authors: Tai
authors: Yenn-Jiang
authors: YJ
authors: Lin
authors: Li-Wei
authors: LW
authors: Lo
authors: Ta-Chuan
authors: TC
authors: Tuan
authors: Ameya R
authors: AR
authors: Udyavar
authors: Yu-Feng
authors: YF
authors: Hu
authors: Hsuan-Ming
authors: HM
authors: Tsao
authors: Chien-Jun
authors: CJ
authors: Chang
authors: Wen-Chin
authors: WC
authors: Tsai
authors: Shih-Ann
authors: SA
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D003452:Cryosurgery / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome