The new tactiflex ablation catheter: reducing the time for radiofrequency atrial fibrillation ablation

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: Public hospital(s). Main funding source(s): Azienda Ospedaliero-Univerisitaria delle Marche BACKGROUND: Pulmonary vein isolation (PVI) by radiofrequency (RF) ablation is a well-established and effective treatment for paroxysmal and persistent atrial fibrillation (AF). Compared to low-power-long-duration (LPLD) RF ablation, the high-power-short duration (HPSD) one produces shallower lesions reducing potential adverse effects, without affecting efficacy. The new TactiFlex Ablation Catheter, Sensor Enabled (TFSE), combining a flexible tip with fiber optic-based contact force sensing, can deliver HSPD RF, obtaining a faster PVI. OBJECTIVE: To test feasibility, safety, and effectiveness of RF AF ablation performed by TFSE, comparing it with LPLD RF AF ablation using TactiCath Contact Force Ablation catheter, Sensor Enabled (TCSE). METHODS: We conducted a prospective study including 50 consecutive patients admitted to our centre for paroxysmal or persistent AF catheter ablation. The patients were randomly divided into 2 groups according to ablation protocol: 25 patients were treated with HPSD performed by TFSE [63 (53-68) years, male 19]; 25 patients were treated with LPLD by TCSE [62 (51-69); male 12). In the HPSD group, the lesions were performed delivering 50W up to 10 seconds with a contact force (CF) index ranging from 5g to 20g. In the LPLD group, the lesions were performed delivering 40W in the anterior segments of veins (LSI 5-5.5) and 35W in the posterior segments (LSI 4-4.5). RESULTS: PVI was achieved in 100% of patients in both groups. No periprocedural complication was reported. No statistically significant differences were found in terms of clinical and echocardiographic characteristics. A significant decrease in PVI time was reported in TFSE group for every pulmonary vein (LSPV: 2.14±0.13 min vs 10.63±5.34, p<0.005; LIPV 2.10±0.12 min vs 10.50±5.56 min, p<0.005; RSPV: 2.20±0.14 min vs 10±6.35 min, p<0.005; RIPV 3.10±5.21 min vs 10.40±8.54 min, p<0.005). No difference was reported for the impendence drop (17 Ω, range 15.3-18 in TFSE vs 15 Ω, range 14.5-17.5 in TCSE, p=0.114). A shorter total procedural time (110 min, range 90-121 vs 155 min, range 128-190, p<0.005) and LA mapping time (8 min, range 6-10 vs 13 min, range 11-14, p<0.005) were reported in TFSE group, while no difference was reported in total fluoroscopy time (16 min, range 12-19.30 vs 19 min, range 14-27, p=0,062). The RF total time was superior in the TCSE group. CONCLUSIONS: In our initial experience, TactiFlex catheter allows a safe, effective and faster PVI in patients affected by paroxysmal and persistent AF undergoing RF ablation. The shorter time for PVI is the main contributor for shortening total procedural times. However, our results have to be confirmed in larger studies. [Figure: see text]