Key result
Left atrial ablation using the TC-SF catheter resulted in audible steam pops in 14% of patients at 10 mL/min irrigation flow and 22% at 20 mL/min, with insufficient feedback to prevent popping.
Observational (n=226)
Absolute Event Rate: 22% vs 14%
The ThermoCool Surround Flow catheter is associated with an unpredictable and relatively high incidence of steam pops during left atrial ablation, which can lead to pericardial tamponade.
May warrant caution with TC-SF catheter in left atrial ablation; leaves open optimal irrigation and safety for prospective trials.
INTRODUCTION: Open irrigated radiofrequency (RF) ablation catheters with a porous tip (56 holes, TC-SF) permit delivering RF energy in a temperature-controlled mode without temperature rise. This prospective observational study investigated the association of different catheter parameters on the occurrence of audible steam pops during left atrial (LA) ablation. METHODS AND RESULTS: A total of 226 patients underwent TC-SF catheter ablation for atrial fibrillation. RF power delivery, impedance and catheter tip temperature were continually recorded throughout the ablation. Pulmonary vein isolation was performed with a maximum of 27 W and LA electrogram-guided or linear ablation with a maximum of 30 W. A total of 59 audible steam pops occurred, 2 of them resulting in pericardial tamponade. In the initial 89 patients, with an irrigation flow rate of 10 mL/min, 18 steam pops with one tamponade occurred in 12 (14%) patients. Subsequently, the irrigation flow rate was increased to 20 mL/min in the following 137 patients, resulting in the occurrence of 41 steam pops including one case of tamponade in a total of 30 (22%) patients. The maximal power was significantly higher in RF applications associated with a pop than those that did not. In only 12 (20%) steam pops, a significant impedance change occurred immediately before pop occurrence (4 [7%] impedance rise >10 ohm, 8 [13%] impedance drop >15 ohm). CONCLUSIONS: The TC-SF catheter does not provide sufficient feedback from the ablated tissue to prevent steam popping.
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Theis et al. (2015) conducted an observational in atrial fibrillation (n=226). Irrigation flow rate of 20 mL/min during TC-SF catheter ablation vs. Irrigation flow rate of 10 mL/min was evaluated on occurrence of audible steam pops. Left atrial ablation using the TC-SF catheter resulted in audible steam pops in 14% of patients at 10 mL/min irrigation flow and 22% at 20 mL/min, with insufficient feedback to prevent popping.