title: Impact of surround flow catheter tip irrigation in contact force ablation on the incidence of asymptomatic oesophageal lesions after atrial fibrillation ablation: a prospective comparative study.
abstract: OBJECTIVE
  Aim of this study was to evaluate the impact of a recently introduced contact force ablation catheter with modified irrigation technology compared with a conventionally irrigated ablation catheter on the incidence of endoscopically detected oesophageal lesions (EDEL).
  
  
  RESULTS
  Patients with symptomatic, drug-refractory paroxysmal or persistent atrial fibrillation (AF) who underwent left atrial radiofrequency (RF) catheter ablation were prospectively enrolled. Patients were ablated using a single-tip RF contact force ablation catheter with conventional irrigation (Group 1; n = 50) or with a recently introduced intensified 'surround flow' irrigation technology (Group 2; n = 50). Assessment of EDEL was performed by oesophagogastroduodenoscopy in all patients after ablation. A total of 100 patients (mean age 63.6 ± 12.1 years; men 58%) with paroxysmal (n = 41; 41%) or persistent AF were included. Groups 1 and 2 patients were comparable in regard to baseline characteristics and procedural parameters, especially ablation time at posterior left atrial wall. Overall, 13 patients (13%) developed EDEL after AF ablation (8 oesophageal ulcerations, 5 erythema). The incidence of EDEL including oesophageal ulcerations was higher in Group 2 compared with Group 1 patients without statistical significance (18 vs. 8%, P = 0.23). One pericardial tamponade and one access site bleeding occurred in Group 2. No further adverse events were reported in both groups.
  
  
  CONCLUSIONS
  According to these preliminary results, the use of an improved ablation catheter irrigation technology (surround flow) in conjunction with contact force measurement was associated with a higher but not statistically significant probability of oesophageal thermal lesions. Further studies including larger patient cohorts are needed.
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt a.d.Saale 97616, Germany.|Department of Cardiology and Angiology, Philipps University Marburg, Marburg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Halbfass
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt a.d.Saale 97616, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Nentwich
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt a.d.Saale 97616, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Krug
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt a.d.Saale 97616, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Roos
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt a.d.Saale 97616, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Sonne
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt a.d.Saale 97616, Germany.
authors.forename: Elena
authors.initials: E
authors.lastname: Ene
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt a.d.Saale 97616, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Hamm
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt a.d.Saale 97616, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Barth
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt a.d.Saale 97616, Germany.
authors.forename: Attila
authors.initials: A
authors.lastname: Szöllösi
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt a.d.Saale 97616, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Fochler
authors.affiliation: University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Mügge
authors.affiliation: Department of Cardiology and Angiology, Philipps University Marburg, Marburg, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Lüsebrink
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt a.d.Saale 97616, Germany.|University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Deneke
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation*; D016009:Chi-Square Distribution; D016145:Endoscopy, Digestive System; D004947:Esophagus / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D007507:Therapeutic Irrigation / Q000009:adverse effects / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014456:Ulcer / Q000175:diagnosis / Q000453:epidemiology*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology*
keywords: Atrial fibrillation; Catheter ablation; Endoscopically detected oesophageal lesion; Improved irrigation technology; Surround flow