A mesh‐type flexible tip catheter vs a contact force catheter for catheter ablation of atrial fibrillation: A prospective nonrandomized 1:1 matched study

Abstract

Introduction: Mesh-type flexible tip (MFT) catheters allow clinicians to safely generate large radiofrequency lesions during catheter ablation of atrial fibrillation (AF), while contact force (CF) catheters provide better catheter-tissue contact. We compared the clinical outcomes of catheter ablation of AF using MFT and CF catheters in a prospective, nonrandomized manner. Methods:We prospectively assigned 217 patients with AF (paroxysmal AF 73.5%; male 69.1%; 59.9 ± 10.7 years old) at a 1:1 ratio to ablation with MFT catheters (FlexAbility) or CF catheters (TactiCath). The primary endpoint was AF recurrence after a single procedure; the secondary endpoint was a response to antiarrhythmic drugs.Results: After a mean follow-up of 22.3 ± 4.4 months, the clinical recurrence rate did not significantly differ between the two study groups (29.7% vs 30.2%; P = .941) (log-rank P = .838). The recurrence rate for atrial tachycardias (30.3% vs 9.7%; P = .035) and cardioversion rates (8.1% vs 1.9%; P = .024) were higher in the MFT group than CF group. At the final follow-up, sinus rhythm was maintained without antiarrhythmic drugs in 57.7% of the MFT group and 40.6% of the CF group (P = .010). No significant difference was found in the major complication rates between the two groups (0.9% vs 5.7%), although the ablation time was significantly longer in the MFT group (4192.1 ± 1080.2 vs 3583.8 ± 977.2 seconds; P < .001).Conclusion: MFT and CF catheters had similar effectiveness in achieving AF rhythm control during catheter ablation, and there was no significant difference between the two catheters with regard to overall safety. K E Y W O R D Satrial fibrillation, catheter ablation, contact force, electrophysiology, recurrence

Detailed investigation of the lesion formation with a novel contact force sensing catheter with a mesh‐shaped irrigation tip

“…Our study compared the lesion formation with the TactiFlex™ SE catheter and its predecessor the FlexAbility™ SE catheter and showed that these were almost similar with the various CF and wattage settings under a 60 s ablation (Figure 2). We speculated that, regardless of the presence of a CF sensor, the current density of the same mesh‐shaped catheter would be similar and would finally create a similar ablation lesion 12 . Likewise, it is reasonable to expect that the same ablation tip would create similar impedance changes.…”

“…We speculated that, regardless of the presence of a CF sensor, the current density of the same mesh‐shaped catheter would be similar and would finally create a similar ablation lesion. 12 Likewise, it is reasonable to expect that the same ablation tip would create similar impedance changes. Moreover, a previous report noted that a parallel catheter placement with FlexAbility™ SE produced larger lesions compared with a perpendicular catheter placement.…”

“… 9 , 10 , 11 A previous study reported that the FlexAbility™ SE catheter had a high recurrence rate of atrial tachycardia after atrial fibrillation (AF) ablation and required a longer ablation time than the TactiCath™ SE catheter, because of the absence of a CF sensor. 12 In more recent days, a novel CF sensing catheter with a mesh‐shaped irrigation catheter (TactiFlex™ SE, Abbott) has been invented and is available for clinical practice. Although this novel catheter helps us to determine the CF information with effective cooling of the distal tip, the detailed influence of the CF sensing equipment with a mesh‐shaped tip on the lesion formation with these catheters remains unknown.…”

“…However, the FlexAbility™ SE catheter does not have a contact force (CF) technology, which helps predict the lesion size and prevent steam pops caused by a high catheter contact with the local tissue 9–11 . A previous study reported that the FlexAbility™ SE catheter had a high recurrence rate of atrial tachycardia after atrial fibrillation (AF) ablation and required a longer ablation time than the TactiCath™ SE catheter, because of the absence of a CF sensor 12 . In more recent days, a novel CF sensing catheter with a mesh‐shaped irrigation catheter (TactiFlex™ SE, Abbott) has been invented and is available for clinical practice.…”

Efficacy and Safety of High-Power Short-Duration Radiofrequency Catheter Ablation of Atrial Fibrillation

“…However, the most consistent evidence suggests that a long-lasting CPVI has the greatest effect on the long-term rhythm outcomes, while AF recurrence without a PV reconnection is associated with poorer rhythm outcomes after a repeat ablation because of AF progression or extra-PV foci (8,13). AFCA outcomes can vary depending on the RF power, catheter design, contact force monitoring, or operator experience (28,29). In this study, we evaluated the efficacy and safety of the HPSD-AFCA, which facilitates a contiguous lesion formation in areas with a relatively thin atrial wall thickness (10).…”