Key result
20-second DiamondTemp ablation reduces RF applications ~38% vs 10-second applications for mitral isthmus block.
Why the study?
The study evaluated the performance of the novel DiamondTemp catheter for mitral isthmus line ablation using two different energy dosing strategies.
Does a 20-second application duration improve procedural efficiency and reduce the need for epicardial ablation compared to a 10-second duration when using the DiamondTemp catheter for mitral isthmus line ablation in patients with recurrent AF/AT?
RCT (n=20)
Open-label
Alternating assignment
No
Does a 20-second application duration improve procedural efficiency and reduce the need for epicardial ablation compared to a 10-second duration when using the DiamondTemp catheter for mitral isthmus line ablation in patients with recurrent AF/AT?
Mitral isthmus line ablation using the temperature-controlled DiamondTemp catheter is feasible and safe, with 20-second applications significantly reducing the total number of radiofrequency applications needed for bidirectional block compared to 10-second applications.
May enhance mitral isthmus ablation efficiency with 20-second DiamondTemp applications; hypothesis-generating pending randomized confirmation of clinical benefit.
Background The novel DiamondTemp™ (DT)-catheter (Medtronic ® ) was designed for high-power, short-duration ablation in a temperature-controlled mode. Aim To evaluate the performance of the DT-catheter for ablation of the mitral isthmus line (MIL) using two different energy dosing strategies. Materials and methods Twenty patients with recurrence of atrial fibrillation (AF) and/or atrial tachycardia (AT) following pulmonary vein (PV) isolation were included. All patients underwent reisolation of PVs in case of electrical reconnection and ablation of a MIL using the DT-catheter. Application durations of 10 (group A, n = 10) or 20 s (group B, n = 10) were applied. If bidirectional block was not reached with endocardial ablation, additional ablation from within the coronary sinus (CS) was conducted. Results In 19/20 (95%) patients, DT ablation of the MIL resulted in bidirectional block. Mean procedure and fluoroscopy time, and dose area product did not differ significantly between the two groups. In group B, fewer radiofrequency applications were needed to achieve bidirectional block of the MIL when compared to group A (26 ± 12 vs. 42 ± 17, p = 0.04). Ablation from within the CS was performed in 8/10 patients (80%) of group A and in 5/10 (50%) patients of group B ( p = 0.34). No major complication occurred. Conclusion Mitral isthmus line ablation with use of the DT-catheter is highly effective and safe. Longer radiofrequency-applications appear to be favorable without compromising safety.
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Rottner et al. (2022) conducted an RCT in Recurrence of symptomatic persistent atrial fibrillation and/or atrial tachycardia (n=20). DiamondTemp ablation system (20 s application) vs. DiamondTemp ablation system (10 s application) was evaluated on Bidirectional conduction block of the mitral isthmus line. Mitral isthmus line ablation using the DiamondTemp catheter achieved bidirectional block in 95% of patients, with 20-second applications requiring significantly fewer radiofrequency applications than 10-second applications (26 vs 42, p=0.04).
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