Comparison of the change in the dimension of the pulmonary vein ostia immediately after pulmonary vein isolation for atrial fibrillation-open irrigated-tip catheters versus non-irrigated conventional 4 mm-tip catheters

Introduction: A difference in the lesion formation between open irrigated-tip (OITC) and non-irrigated 4-mm-tip catheters (NITC) may result in a difference in the dimension of the pulmonary vein (PV) ostia after PV isolation of atrial fibrillation (AF). This study evaluated the difference using intracardiac echocardiography (ICE) before and immediately after an extensive encircling PV isolation (EPVI) with an OITC and with an NITC.

Methods and results: We studied 100 consecutive patients (OITC group, 54; NITC group, 46) who received EPVI. Changes in the vessel, lumen, and wall thickness areas of the PVs were evaluated at the PV ostia by ICE. There were no significant differences in the baseline characteristics and acute success rate of the EPVI between the OITC and NITC groups. The energy delivered to achieve EPVI was higher in the OITC group than that in the NITC group (34,967 ± 13,222 J vs. 28,300 ± 10,614 J; p = 0.01). After the ablation, the reduction in the vessel and lumen cross-sectional areas was significantly smaller in the OITC group than that in the NITC group (−9.05 ± 28.4 % vs. −21.2 ± 28.8 %, p < 0.001; −8.76 % vs. −17.7 ± 26.9 %, p = 0.003). The wall thickness area slightly decreased in the OITC group, but increased in the NITC group (−2.96 ± 38.4 % vs. 10.5 ± 76.6 %, p = 0.591). During a median follow-up of 234 days, there was no significant difference in the AF recurrence after the initial ablation procedure between the two groups.

Conclusion: Greater PV ostial narrowing occurred with the NITC than OITC immediately after the EPVI. PV ostial wall edema was noted with only the NITC. These findings suggested that an OITC might reduce any acute PV narrowing and wall edema as compared with an NITC.