title: Superiority of gold versus platinum irrigated tip catheter ablation of the pulmonary veins and the cavotricuspid isthmus: a randomized study comparing tip temperatures and cooling flow requirements.
abstract: BACKGROUND
  In order to optimize power delivery into the myocardium during radiofrequency ablation (RFA) without overheating the electrode tip, active cooling of the tip electrode as well as electrode tips made of gold have evolved. Recently, an externally irrigated gold tip electrode ablation catheter has been developed to combine the advantages of these 2 technologies. We sought to investigate the procedural parameters tip temperature, delivered power and cooling flow requirements of the irrigated gold tip catheter in comparison to the conventional irrigated platinum iridium (Pt) tip catheter in pulmonary vein isolation (PVI) and cavotricuspid isthmus (CTI) ablation.
  
  
  RESULTS
  Sixty patients referred for first PVI were randomized into ablation with irrigated gold tip catheter versus irrigated Pt tip catheter. Forty-nine patients received ablation of CTI following PVI. Mean and standard deviation from all measurements were calculated for each patient. During RFA of pulmonary veins, mean catheter tip temperature was significantly lower in the gold group (35.4 ± 0.9 °C vs 38.2 ± 0.8 °C, P < 0.001), and total amount of delivered energy was higher (1303.1 ± 81.1 W vs 1223.7 ± 115.6 W, P = 0.004). During CTI ablation, necessary saline flow was almost 2.5-fold lower in the gold group (22.5 ± 5.9 mL/min vs 52.5 ± 9.7 mL/min, P < 0.001), accompanied by significantly lower tip temperature (39.1 ± 0.6 °C vs 40.5 ± 1.4 °C, P < 0.001).
  
  
  CONCLUSIONS
  The irrigated gold tip electrode allows to deliver significantly more energy at a lower electrode tip temperature in RFA of PV and CTI in comparison to the irrigated Pt tip electrode. The required saline flow during CTI ablation is much lower than in Pt.
authors.affiliation: Department of Medicine-Cardiology, University of Bonn, Sigmund-Freud, Bonn, Germany. markus.linhart@ukb.uni-bonn.de
authors.forename: Markus
authors.initials: M
authors.lastname: Linhart
authors.forename: Ilja
authors.initials: I
authors.lastname: Liberman
authors.forename: Jan Wilko
authors.initials: JW
authors.lastname: Schrickel
authors.forename: Erica Lilian
authors.initials: EL
authors.lastname: Mittmann-Braun
authors.forename: René
authors.initials: R
authors.lastname: Andrié
authors.forename: Florian
authors.initials: F
authors.lastname: Stöckigt
authors.forename: Jens
authors.initials: J
authors.lastname: Kreuz
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.forename: Lars Martin
authors.initials: LM
authors.lastname: Lickfett
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation*; D057785:Catheters; D004867:Equipment Design; D005260:Female; D005858:Germany; D006046:Gold; D006358:Hot Temperature; D006801:Humans; D008297:Male; D008875:Middle Aged; D010984:Platinum; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D007507:Therapeutic Irrigation / Q000295:instrumentation*; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000503:physiopathology / Q000601:surgery*
chemical_list: D010984:Platinum; D006046:Gold