Randomized Comparison Between Open Irrigation Technology and Intracardiac-Echo-Guided Energy Delivery for Pulmonary Vein Antrum Isolation: Procedural Parameters, Outcomes, and the Effect on Esophageal Injury


  • Information from this study was presented at the 2006 HRS meeting.

  • Dr. Noelker received support from BARD.

  • Manuscript received 13 September 2006; Revised manuscript received 16 January 2007; Accepted for publication 7 February 2007.

Address for correspondence: Nassir F. Marrouche, M.D., Director, Atrial Fibrillation Program, Division of Cardiology, University of Utah Health Sciences Center, 30 North 1900 East Room 4A100, Salt Lake City, UT 84132-2400. Fax: +1-581-7735; E-mail: nassir.marrouche@hsc.utah.edu


Introduction: We performed a prospective study to compare efficacy and safety of both open irrigation tip (OIT) technology with intracardiac echo (ICE)-guided energy delivery in patients presenting for PVAI.

Methods and Results: Fifty-three patients presenting for PVAI were randomized to ablation using an OIT catheter (Group 1, 26 patients; temperature and power were set at 50° and 50 W, respectively, with a saline pump flow rate of 30 mL/min) or radiofrequency (RF) energy delivery under ICE guidance (Group 2, 27 patients; energy was titrated based on microbubbles formation). The mean procedure time and fluoroscopy exposure were lower in Group 1 (164 ± 42 min and 7,560 ± 2,298 μGraym2 vs 204 ± 47 min and 12,240 ± 4,356 μGraym2; P = 0.005 and 0.008, respectively). Moreover, the durations of RF lesions applied per PV antrum was lower in Group 1 compared with Group 2 (5.1 ± 2.2 min vs 9.2 ± 3.2 min, P = 0.03, respectively). Within 24 hours after PVAI in 35.7% (all erythema) of Group 1 and 57.1% (21.4% erythema and 35.7% necrosis) of Group 2, patients' esophageal wall changes were documented. After 14 ± 2 months of follow up, recurrences were documented in 19.2% of Group 1 and 22.2% of Group 2 patients.

Conclusion: Although both OIT and ICE-guided energy delivery possess a similar effect in treating AF, OIT seems to be superior in terms of achieving isolation and shortening fluoroscopy exposure. Moreover, a lower incidence of esophageal wall injury was observed utilizing OIT for PVAI.