Acute safety of an open-irrigated ablation catheter with 56-hole porous tip for radiofrequency ablation of paroxysmal atrial fibrillation: analysis from 2 observational registry studies

Saumil R Oza, Tina D Hunter, Angelo B Biviano, Gopi Dandamudi, Bengt Herweg, Anshul M Patel, Scott J Pollak, Huijian Wang, Robert S Fishel, Saumil R Oza, Tina D Hunter, Angelo B Biviano, Gopi Dandamudi, Bengt Herweg, Anshul M Patel, Scott J Pollak, Huijian Wang, Robert S Fishel

Abstract

Introduction: This report presents safety data on the use of a new open-irrigation radiofrequency ablation (RFA) catheter with a 56-hole porous tip in 742 patients enrolled in 2 US prospective, multicenter observational registry studies representing real-world use of the catheter.

Methods: This analysis is comprised of patients who underwent RFA of drug-refractory recurrent symptomatic paroxysmal atrial fibrillation (AF). Acute adverse events (AEs) were collected and categorized by seriousness, timing, and relatedness, with 7 days of follow-up data in one study and at least 120 days of data from a 1-year follow-up in the other. Acute serious adverse events (SAEs) that were identified as potentially related to the device and/or procedure were adjudicated by an independent safety committee.

Results: A total of 30 patients (4.0%) in the combined studies experienced an acute SAE related to the device and/or procedure, which was similar in the subset of patients age 65 and over (4.2%). These SAEs included 1.2% cardiac tamponade/perforation, 0.7% pericarditis, 0.5% pulmonary events, and 0.8% vascular access complications. No myocardial infarction, stroke, transient ischemic attack, or atrioesophageal fistulas within 7 days postprocedure were reported. In the study with extended follow-up, 1 pulmonary vein stenosis and 1 esophageal injury were seen beyond 7 days postprocedure (0.2% each). There were no device or procedure related deaths.

Conclusion: Results from 2 large observational studies demonstrated that a new porous tip RFA catheter was safe for the treatment of drug refractory, recurrent, symptomatic paroxysmal AF, including treatment of older patients (≥65 years).

Keywords: acute safety; atrial fibrillation; catheter ablation; complications; thermocool SF catheter.

© 2014 The Authors Journal of Cardiovascular Electrophysiology Published by Wiley Periodicals, Inc.

References

    1. Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, Kim YH, Klein G, Natale A, Packer D, Skanes A, Ambrogi F, Biganzoli E. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol. 2010;3:32–38.
    1. Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, Crijns HJ, Damiano RJ, Jr, Davies DW, DiMarco J, Edgerton J, Ellenbogen K, Ezekowitz MD, Haines DE, Haissaguerre M, Hindricks G, Iesaka Y, Jackman W, Jalife J, Jais P, Kalman J, Keane D, Kim YH, Kirchhof P, Klein G, Kottkamp H, Kumagai K, Lindsay BD, Mansour M, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Nakagawa H, Natale A, Nattel S, Packer DL, Pappone C, Prystowsky E, Raviele A, Reddy V, Ruskin JN, Shemin RJ, Tsao HM, Wilber D. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2012;9:632–696.
    1. FDA News & Events. FDA Approves First Ablation Catheters for the Treatment of Atrial Fibrillation. 2009. . Accessed February 6,
    1. FDA Approval of premarket approval application (PMA) for the NaviStar™ DS and Celsius™ DS Diagnostic/Ablation Catheters, Stockert 70 Generator and accessories. 2002. . Accessed September,
    1. Park CI, Lehrmann H, Keyl C, Weber R, Schurr P, Schiebeling-Romer J, Allgeier J, Herrera CS, Kienzle RP, Shah D, Neumann FJ, Arentz T, Jadidi AS. Enhanced efficiency of a novel porous tip irrigated RF ablation catheter for pulmonary vein isolation. J Cardiovasc Electrophysiol. 2013;24:1328–1335.
    1. Scaglione M, Blandino A, Raimondo C, Caponi D, Di Donna P, Toso E, Ebrille E, Cesarani F, Ferrarese E, Gaita F. Impact of ablation catheter irrigation design on silent cerebral embolism after radiofrequency catheter ablation of atrial fibrillation: Results from A pilot study. J Cardiovasc Electrophysiol. 2012;23:801–805.
    1. Bertaglia E, Fassini G, Anselmino M, Stabile G, Grandinetti G, De Simone A, Calo L, Pandozi C, Pratola C, Zoppo F, Tondo C, Iuliano A, Gaita F. Comparison of ThermoCool(R) Surround Flow catheter versus ThermoCool(R) catheter in achieving persistent electrical isolation of pulmonary veins: A pilot study. J Cardiovasc Electrophysiol. 2013;24:269–273.
    1. Raimondo C, Ebrille E, Caponi D, Di Donna P, Di Clemente F, Appendino M, Giorgetti A, Battaglia A, Gaita F, Scaglione M. AF ablation: Evaluation of procedural parameters and acute results comparing ablation catheters with traditional and new irrigation design. Eur Heart J. 2013;34(S1):94.
    1. Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, Singer DE. Prevalence of diagnosed atrial fibrillation in adults: National implications for rhythm management and stroke prevention: The AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285:2370–2375.
    1. Waldo AL, Wilber DJ, Marchlinski FE, Stevenson WG, Aker B, Boo LM, Jackman WM. Safety of the open-irrigated ablation catheter for radiofrequency ablation: Safety analysis from six clinical studies. Pacing Clin Electrophysiol. 2012;35:1081–1089.
    1. Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, Kim YH, Klein G, Natale A, Packer D, Skanes A. Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation. J Am Coll Cardiol. 2009;53:1798–1803.
    1. Santucci PA, Thomas K, Vasaiwala S, Cytron J, Green A, Winterfield J, Wilber D. Initial experience of major complications with a 56 hole irrigated ablation catheter. Heart Rhythm. 2013;10:S32.
    1. Di BiaseL, Santangeli P, Bai R, Mohanty P, Mohanty S, Trivedi C, Price J, Yan R, Horton R, Sanchez J, Gallinghouse J, Beheiry S, Hongo R, Zagrodzky J, Canby R, Dello Russo A, Casella M, Fassini G, Carbucicchio C, Tondo C, Natale A. Impact of a new open irrigated catheter on the risk of fluid overload after ablation of long standing persistent atrial fibrillation results from a prospective randomized study. J Am Coll Cardiol. 2013;61:E320.
    1. Fichtner S, Reents T, Ammar S, Jilek C, Pavaci H, Kathan S, Hessling G, Deisenhofer I. Contact force-aided pulmonary vein isolation in patients with paroxysmal atrial fibrillation—Initial experience. J Interv Card Electrophysiol. 2012;33:336.
    1. Mathew S, Furnkranz A, Metzner A, Rillig A, Tilz RR, Wissner E, Yashuiro Y, Konstaninou M, Work R, Ouyang F, Kuck KH. First experience with a novel irrigated tip catheter with 56 holes: Assessment of acute success rate and incidence of esophageal lesion formation. Clin Res Cardiol. 2011;100
    1. Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, Kim YH, Klein G, Packer D, Skanes A. Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation. 2005;111:1100–1105.
    1. Singh SM, d’Avila A, Doshi SK, Brugge WR, Bedford RA, Mela T, Ruskin JN, Reddy VY. Esophageal injury and temperature monitoring during atrial fibrillation ablation. Circ Arrhythm Electrophysiol. 2008;1:162–168.
    1. Halm U, Gaspar T, Zachaus M, Sack S, Arya A, Piorkowski C, Knigge I, Hindricks G, Husser D. Thermal esophageal lesions after radiofrequency catheter ablation of left atrial arrhythmias. Am J Gastroenterol. 2010;105:551–556.
    1. FDA Summary of Safety and Effectiveness Data. . Accessed November 12, 2013.

Source: PubMed

3
Se inscrever