title: Radiofrequency Ablation with an Enhanced-Irrigation Flexible-Tip Catheter versus a Standard-Irrigation Rigid-Tip Catheter.
abstract: BACKGROUND
  The flexible-tip irrigated ablation catheter Cool Flex™ (St. Jude Medical, St. Paul, MN, USA) was introduced to enhance cooling of the catheter-tissue interface and to conform to endocardial surface with better contact. Little is known about the performance of such catheter design compared to the widely used rigid-tip catheters.
  
  
  METHODS
  In a thigh muscle preparation, ablation using the flexible-tip and rigid-tip catheters was performed in seven pigs across a range of ablation settings and catheter orientation. Postprocedure, the thigh muscle was stained with 2,3,5-triphenyltetrazolium-chloride injected into the femoral artery. The muscle was excised, fixed with formalin, and examined grossly.
  
  
  RESULTS
  A total of 196 lesions (95 flexible tip, 101 rigid tip) were evaluated. The flexible-tip catheter was associated with enhanced cooling of catheter-tissue interface (31.1 ± 3.3°C vs 36.3 ± 3.7°C, P = 0.0001) in both perpendicular and nonperpendicular catheter orientations. This allowed more energy delivery (37.3 ± 8.9 W vs 33.7 ± 8.1 W, P = 0.004) to targeted tissue and resulted in larger lesions (median 194.7 [interquartile range: 113.1-333.8] mm(3) vs 170.9 [88.7-261.6] mm(3) , P = 0.03) than the rigid-tip catheter with larger maximum diameter (11.1 ± 2.6 mm vs 10.3 ± 2.1 mm, P = 0.03) and larger diameter at tissue surface (10.3 ± 2.4 mm vs 9.6 ± 1.7 mm, P = 0.01). Catheter orientation during ablation affected the efficiency of rigid-tip but not the flexible-tip catheter. The use of the flexible-tip catheter was associated with significantly less char formation on tissue (none vs 5.1% with rigid tip, P = 0.009).
  
  
  CONCLUSIONS
  The Cool Flex™ catheter performed better than a rigid-tip catheter with enhanced cooling, larger ablation lesions, and no charring of targeted tissue.
authors.affiliation: Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Ayman A
authors.initials: AA
authors.lastname: Hussein
authors.affiliation: Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Carlos
authors.initials: C
authors.lastname: Oberti
authors.affiliation: Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Oussama M
authors.initials: OM
authors.lastname: Wazni
authors.affiliation: St. Jude Medical, St. Paul, Minnesota.
authors.forename: Jami A
authors.initials: JA
authors.lastname: Hegrenes
authors.affiliation: St. Jude Medical, St. Paul, Minnesota.
authors.forename: John A
authors.initials: JA
authors.lastname: Sral
authors.affiliation: Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: John
authors.initials: J
authors.lastname: Lopez
authors.affiliation: Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: William
authors.initials: W
authors.lastname: Kowalewski
authors.affiliation: Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Kattar
authors.affiliation: Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Kanj
authors.affiliation: Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Bruce
authors.initials: B
authors.lastname: Lindsay
authors.affiliation: Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
mesh_terms: D000818:Animals; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000295:instrumentation*; D055119:Elastic Modulus; D004867:Equipment Design; D019544:Equipment Failure Analysis; D006801:Humans; D007036:Hypothermia, Induced / Q000295:instrumentation*; D018482:Muscle, Skeletal / Q000473:pathology* / Q000601:surgery*; D013552:Swine; D007507:Therapeutic Irrigation / Q000295:instrumentation*; D016896:Treatment Outcome
keywords: ablation; experimental; flexible tip catheter; new technology