Pulmonary vein isolation using a higher power shorter duration CLOSE protocol with a surround flow ablation catheter

Abstract

Introduction The CLOSE protocol combines ablation index (AI) and ≤6 mm interlesion distance using standard power settings for the treatment of atrial fibrillation (AF). The purpose was to compare the safety and efficacy of a conventional CLOSE and a higher power shorter duration (HPSD)‐CLOSE pulmonary vein isolation (PVI) strategy. Methods and Results All consecutive patients referred for PVI were included after informed consent was obtained from them. Group 1 was treated with a standard CLOSE protocol and group 2 with a HPSD‐CLOSE protocol (45 W anterior and 35 W posterior). Procedural parameters and 6‐month follow‐up were analyzed. In total, 174 patients (group 1: n = 94 [paroxysmal: n = 74]; group 2: n = 80 [paroxysmal: n = 65], similar baseline characteristics) were included. PVI was reached in all, but procedure duration (82 ± 18 minutes vs 100 ± 22 minutes; P < .0001) and radiofrequency (RF) time (23 ± 5 minutes vs 36 ± 11 minutes; P < .0001) was shorter in group 2. First pass isolation was similar in groups 2 and 1 (left veins: 94% vs 90%; P = .42 and right veins: 83% vs 84%; P = .79, respectively). Six‐month off‐ antiarrhythmic drugs freedom of AF/AT was similar in groups 2 and 1 (82% [paroxysmal: 86%] vs 83% [paroxysmal: 88%]; P = .93, respectively). Major complications were similar (group 2: 1% vs group 1: 3%; P = .39). Conclusion A higher‐power short duration approach can shorten a CLOSE procedure and reduce ablation time without having a negative impact on safety or efficiency.

Safety and efficacy of the ThermoCool SmartTouch SurroundFlow catheter for atrial fibrillation ablation: A meta‐analysis

“…This hypothesis was supported by some clinical trials. Bertaglia et al reported a RCT study between SFc and TCc, and observed a similar 6 months follow‐up success rate between for both groups, which finding was in line with Park et al The possible mechanism might have involved an observation of no significant differences in regard to RF power delivery or lesion size between SFc and TCc . Therefore, both STSFc and STc share CF‐sensing technology, which results in similarly long‐term success rates between two groups.…”

“…Bertaglia et al reported a RCT study between SFc and TCc, and observed a similar 6 months follow-up success rate between for both groups, which finding was in line with Park et al 6,9 The possible mechanism might have involved an observation of no significant differences in regard to RF power delivery or lesion size between SFc and TCc. 30 to excessive fluid delivery during the procedure. The STSFc procedure uses more homogeneous cooling of the whole tip, so less irrigation fluid is needed.…”

How much is enough? An appraisal of high‐power short‐duration radiofrequency ablation for pulmonary vein isolation

“…However, no cardiac tamponade or atrio-esophageal fistulas or PV stenoses were noted in study. 11 Berte, et al 12 ≥450 at the roof and inferior regions). Esophageal temperature monitoring was standard-of-care.…”

“…Berte, et al in this issue of the JCE, have carried out an elegant single‐center nonrandomized study comparing two different strategies of RF energy application for PVI using the CLOSE protocol in patients with paroxysmal AF (80%) and persistent AF (20%). They have tested the efficacy and safety of a “high‐power short duration (HPSD)” RF energy application compared to the conventional power settings.…”

“…The authors have reported a significant reduction in fluoroscopy, ablation and procedural times with no compromise on efficacy and safety. 12 A comparison of the procedural times along with the reported safety and efficacy outcomes for each strategy are outlined in Table 1.…”