Slit-based irrigation catheters can reduce procedure-related ischemic stroke in atrial fibrillation patients undergoing radiofrequency catheter ablation

Abstract

Open irrigation ablation catheters are now the standard in radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Among various irrigation catheters, laser-cut slit-based irrigation system (Cool Flex and FlexAbility) has a unique design to cool the catheter tip more efficiently. We aimed to assess the safety of slit-based irrigation catheters regarding prevention of procedure-related ischemic complication in AF patients undergoing RFCA. The analysis was performed with Korea University Medicine Anam Hospital RFCA registry. Procedure-related ischemic complication was defined as ischemic stroke or transient ischemic attack (TIA) occurring within 30 days after RFCA. Patients were divided into 3 groups: non-irrigation, hole-based irrigation, and slit-based irrigation catheter groups. A total of 3,120 AF patients underwent first RFCA. Non-irrigation, non-slit-based irrigation, and slitbased irrigation catheters were used in 290, 1,539, and 1,291 patients, respectively. As compared with non-irrigation and non-slit-based irrigation catheter groups, slit-based irrigation catheter group had significantly older age, higher prevalence of non-paroxysmal AF, large left atrial size, and decreased left atrial appendage flow velocity. The CHA 2 DS 2-VASc score was not different among the 3 groups. Procedure-related ischemic complication occurred in 17 patients (0.54%) with 16 ischemic strokes and 1 TIA event: 5/290 (1.72%), 11/1,539 (0.71%), and 1/1,291 (0.08%) events in non-irrigation, non-slit-based irrigation, and slit-based irrigation catheter groups, respectively (p = 0.001). Slit-based irrigation catheter was superior in direct comparison with non-slit-based irrigation catheter (0.71% vs. 0.08%; p = 0.009). Slit-based irrigation catheters were highly effective in preventing procedure-related ischemic complications.

Cardiocerebrovascular benefits of early rhythm control in patients with atrial fibrillation detected after stroke: a systematic review and meta-analysis

“…However, the clinical benefit of rhythm control therapy for AFDAS patients is still uncertain. Due to the associated risks of stroke, thromboembolism, and atrio-esophageal fistula following catheter ablation ( 11 , 12 ), there is a tendency in clinical practice to avoid prescribing rhythm control therapy for AFDAS considering the real clinical benefit and cost-effectiveness ratio ( 13 ).…”

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

“…Recently, the latest iteration with a mesh‐shaped tip design has been introduced (FlexAbility™ SE, Abbott) 6,7 . Thanks to the novel tip design, the irrigation flow rate of these products has been substantially reduced from 30 to 13 mL/min while it promises a reduction in the incidence of char and thrombus formation, 5 and a recent study reported that mesh‐shaped irrigation catheters are highly effective in preventing procedure‐related ischemic complications 8 . 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 .…”

“… 6 , 7 Thanks to the novel tip design, the irrigation flow rate of these products has been substantially reduced from 30 to 13 mL/min while it promises a reduction in the incidence of char and thrombus formation, 5 and a recent study reported that mesh‐shaped irrigation catheters are highly effective in preventing procedure‐related ischemic complications. 8 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 , 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.…”