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Europace Advance Access published online on May 29, 2008
Europace, doi:10.1093/europace/eun144
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Cooled-tip vs. 8 mm-tip catheter for circumferential pulmonary vein ablation: comparison of efficacy, safety, and lesion extension

Maria Matiello, Lluis Mont*, David Tamborero, Antonio Berruezo, Begoña Benito, Eric Gonzalez and Josep Brugada

Arrhythmia Section, Thorax Institute, Hospital Clinic, Institut de Investigació Biomédica IDIBAPS, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain

Aims: In many laboratories, cooled-tip catheters have replaced 8 mm-tip catheters due to their theoretical advantage of achieving larger lesions and avoiding charring. However, direct comparisons between the catheters in the subset of atrial fibrillation (AF) ablation are scarce. The aim of this study was to compare the efficacy, safety, and lesion extension created by 8 mm-tip vs. cooled-tip catheter with different energy settings for circumferential pulmonary vein ablation (CPVA).

Methods and results: A series of 221 consecutive patients with symptomatic AF were included in the study. Circumferential pulmonary vein ablation was performed using an 8 mm-tip catheter (55 W, 50°C) in 90 patients (Group 1), a cooled-tip (30 W, 45°C) in 42 (Group 2), and a cooled-tip (40 W, 45°C) in 89 (Group 3). In a subgroup of 60 patients, troponin I (TpnI), creatinine kinase, and myoglobin values were obtained before and at 12 and 24 h after ablation. At 1 year follow-up, the probability of being arrhythmia-free after a single procedure was 53, 35, and 55% in patients from Groups 1, 2, and 3, respectively. Ablation with a cooled-tip catheter at 30 W led to a higher recurrence rate (P = 0.030) and was identified in Cox regression analysis as an independent predictor of AF recurrence (HR, 1.713; 95% CI, 1.02–2.90; P = 0.045). There were no differences in intra-procedure complications (2.2 vs. 5.6 vs. 4.9%, P = 0.542). The myocardial lesion according to TpnI was smaller in Group 2 (P = 0.02).

Conclusion: The cooled-tip catheter at 30 W was less efficacious than both the 8 mm catheter and the cooled-tip with a 40 W power setting.

Key Words: Atrial fibrillation, Arrhythmia, Radiofrequency catheter ablation

* Corresponding author. Tel: +34 93 227 5551; fax: +34 93 451 3045. E-mail address: lmont{at}clinic.ub.es

Manuscript submitted 5 February 2008. Accepted after revision 8 May 2008.


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