Key result
Dual-energy DE STSF catheter achieves ~72% 1-year freedom from atrial arrhythmia in paroxysmal AF.
Why the study?
Does the dual-energy RF and PFA catheter safely and effectively treat paroxysmal atrial fibrillation?
Does the dual-energy RF and PFA catheter safely and effectively treat paroxysmal atrial fibrillation?
The dual-energy DE STSF catheter shows promising safety and mid-term efficacy for paroxysmal AF, though current evidence is limited to single-arm data.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Early results from the SmartfIRE study show that the use of the Dual Energy THERMOCOOL SMARTTOUCH SF ablation system led to complete 3-month acute procedural success in patients with paroxysmal AFib, while demonstrating the seamless transition of ablation workflow to a dual energy platform. Having the ability to easily switch between RF and PF energy provides the flexibility to customize treatment depending on the patient anatomy and clinical need, enabling electrophysiologists to perform more targeted ablation procedures which could lead to improved outcomes for patients.”
“With an efficacy rate of 86.9% with high adherence to the recommended ablation protocol leveraging the PF & RF Tag Index, the 12-month SmartfIRE data supports the effectiveness, safety, and clinical benefits of ablation performed with the Dual Energy Thermocool Smarttouch SF Catheter.”
“The Dual Energy STSF Catheter is an exciting innovation because it allows customization of treatment by switching between radiofrequency and pulsed field energy. The ability to deliver both types of energy via one catheter simplifies the workflow for ablation procedures, while integration with the Carto 3 Mapping System enables real-time catheter visualization and feedback on contact force measurements and ablation indexes – important factors for durable lesion formation.”
Supports dual-energy focal ablation for paroxysmal AF; extends integrated RF-PFA platform evidence from first-in-human data.
Background The Dual-Energy THERMOCOOL SMARTTOUCH® SurroundFlow (DE STSF) catheter combines radiofrequency (RF) and pulsed field ablation (PFA) within a single contact force-sensing, irrigated-tip focal platform, fully integrated with the CARTO® 3 three-dimensional mapping system.Methods We reviewed available preclinical and clinical evidence on the DE STSF catheter, including the first-in-human SmartfIRE trial and supporting preclinical studies.Results Preclinical data established comparable lesion durability between focal PF and RF ablation, superior scar maturity with PFA, a validated PF ablation index based on contact force and pulse count, and synergistic lesion depth enhancement with sequential RF+PFA delivery. In the SmartfIRE study (n = 149, 9 European centers), acute procedural success was 100%, with no atrio-esophageal fistula, phrenic nerve palsy, or stroke reported. Freedom from atrial arrhythmia recurrence at 12 months reached 71.5% overall and 86.9% in patients treated with high adherence to the dual-index guided workflow.Conclusion The DE STSF catheter offers a clinically flexible, index-guided dual-energy approach with a favorable safety profile and promising mid-term efficacy, although this evidence derives from a single-arm study lacking randomized or head-to-head comparative data and should be considered hypothesis-generating. Evidence remains limited to paroxysmal AF, and dedicated comparative studies in persistent AF and ventricular arrhythmias are warranted.
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Cherbi et al. (2026) conducted a review in Atrial fibrillation (n=149). Dual-Energy THERMOCOOL SMARTTOUCH SurroundFlow (DE STSF) catheter was evaluated on Freedom from atrial arrhythmia recurrence at 12 months. The dual-energy DE STSF catheter achieved 100% acute procedural success and 71.5% freedom from atrial arrhythmia recurrence at 12 months in patients with paroxysmal atrial fibrillation.
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