Impact of Tip Design and Thermocouple Location on the Efficacy and
Safety of Radiofrequency Application
Abstract
Background & Objectives The FlexAbilityTM SE catheter has a laser-cut
8Fr 4-mm flexible tip irrigated through laser-cut kerfs with a
thermocouple 0.3mm from the distal end. The TactiCathTM SE catheter has
an 8Fr 3.5-mm tip and 6-irrigation port with a thermocouple 2.67mm
proximal to the tip. We investigated the impact of these differences on
the efficacy and safety of RF-applications. Methods RF applications at a
range of powers (20W, 30W, and 40W), contact forces (5g, 15g, and 25g),
and durations (10-60s) using perpendicular/parallel catheter
orientation, were performed in excised porcine hearts. Lesion
characteristics and incidence of steam pops were compared. Results 540
lesions were examined. The FlexAbilityTM SE catheter produced smaller
lesion depths (4.0mm vs. 4.4mm, p=0.014 at 20W; 4.6mm vs. 5.6mm, p=0.015
at 30W), surface areas (22.7mm2 vs. 29.2mm2 at 20W, p=0.005; 23.2mm2 vs.
28.7mm2, p=0.009 at 30W) and volumes (126.1mm3 vs. 175.1mm3, p=0.018 at
20W; 183.2mm3 vs. 304.3mm3, p=0.002 at 30W) with perpendicular catheter
placement. However, no differences were observed with parallel catheter
placement. Steam-pops were significantly less frequently observed with
the FlexAbilityTM SE catheter (4% vs. 22%, p<0.001)
irrespective of catheter direction to the tissue. Multivariate analysis
showed that use of the TactiCathTM SE catheter, power ≥40W, contact
force ≥25g, RF duration >30s, parallel angle and impedance
drop ≥20Ω were significantly associated with occurrence of steam-pops.
Conclusions The FlexAbilityTM SE catheter reduced the risk of
steam-pops, but produced smaller lesions with perpendicular catheter
placement compared to the TactiCathTM SE catheter.