title: Clinical experience with contact-force and flexible-tip ablation catheter designs.
abstract: OBJECTIVE
  Lesion formation is a critical determinant of technical and clinical success of pulmonary vein isolation. Different catheter designs aim to enhance tissue contact during ablation to enable optimized lesion formation. We analyzed procedural characteristics and predictors of clinical success in patients ablated with three different contemporary ablation catheters.
  
  
  METHODS
  Two hundred sixty-eight sequentially included patients receiving pulmonary vein isolation (PVI) with conventional (n = 122), contact-force (n = 96) and flexible-tip (n = 60) catheters were followed for a median of 14.1 months with 7d-Holter-monitoring and TTE at 3, 6, 12, and 24 months. Baseline characteristics and follow-up times were homogeneous across all groups.
  
  
  RESULTS
  Multivariable Cox proportional hazard regression for arrhythmia recurrence demonstrated a favorable hazard ratio for contact-force and flexible-tip catheters vs. conventional open irrigation catheters. Procedure time and fluoroscopy time were shorter for contact-force and flexible-tip catheters versus conventional catheters, but equal between. Linear lesions were applied in 58 % of contact-force and 66 % of flexible-tip cases, and CFAEs were targeted in 26 % of either.
  
  
  CONCLUSIONS
  Our non-randomized prospectively collected data do not show a difference in observed procedure characteristics and in clinical outcome for flexible-tip versus contact-force catheter designs, while both display improved performance against conventional open irrigated-tip catheters. Linear lesions and CFAEs ablation were not associated with improved arrhythmia-free survival.
authors.affiliation: Electrophysiology Department, Kerckhoff Heart Centre, Benekestr. 2-6, 61231, Bad Nauheim, Germany. deubner@gmail.com.
authors.forename: N
authors.initials: N
authors.lastname: Deubner
authors.affiliation: Electrophysiology Department, Kerckhoff Heart Centre, Benekestr. 2-6, 61231, Bad Nauheim, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Greiss
authors.affiliation: Electrophysiology Department, Kerckhoff Heart Centre, Benekestr. 2-6, 61231, Bad Nauheim, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Akkaya
authors.affiliation: Electrophysiology Department, Kerckhoff Heart Centre, Benekestr. 2-6, 61231, Bad Nauheim, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Berkowitsch
authors.affiliation: Electrophysiology Department, Kerckhoff Heart Centre, Benekestr. 2-6, 61231, Bad Nauheim, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Zaltsberg
authors.affiliation: Electrophysiology Department, Kerckhoff Heart Centre, Benekestr. 2-6, 61231, Bad Nauheim, Germany.
authors.forename: C W
authors.initials: CW
authors.lastname: Hamm
authors.affiliation: Electrophysiology Department, Kerckhoff Heart Centre, Benekestr. 2-6, 61231, Bad Nauheim, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Kuniss
authors.affiliation: Electrophysiology Department, Kerckhoff Heart Centre, Benekestr. 2-6, 61231, Bad Nauheim, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Neumann
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data*; D018572:Disease-Free Survival; D055119:Elastic Modulus; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data*; D015995:Prevalence; D012008:Recurrence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013314:Stress, Mechanical; D016896:Treatment Outcome
keywords: Atrial fibrillation; Clinical outcomes; Contact force; Flexible tip; Linear lesions; Pulmonary vein isolation