Abstract 18879: Procedural Success in the CONFIRM Trial is Independent of Use of Irrigated or Non-irrigated Ablation Catheters
Introduction: Irrigated ablation catheters have become the preferred radiofrequency (RF) catheter for atrial fibrillation (AF) ablation due to greater energy delivery, particularly in areas of low blood flow. We hypothesized, however, for AF ablation not routinely incorporating mitral isthmus ablation (and therefore minimizing ablation within the coronary sinus), that non-irrigated ablation catheters would be non-inferior to irrigated catheters.
Methods: We analyzed the results of the CONFIRM (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation, FIRM) trial with respect to type of ablation catheter used: irrigated (8.5 French, Thermocool, Biosense-Webster, Diamond Bar, CA) and non-irrigated (8 French, 8-mm tip, Blazer XP, Boston Scientific, Natick, MA). We analyzed the FIRM-guided and FIRM-blinded ablation limbs separately; analysis was performed on an intention-to-treat basis, and crossovers were not permitted. Statistics were calculated using SPSS Version 19 (IBM, Armonk, NY).
Results: In 92 patients (age 62±9 y, EF 54±14%) undergoing 107 consecutive ablation procedures, overall freedom from AF and all atrial tachyarrhythmias (ATs) was 70.6% in the FIRM-guided and 39.1% in the FIRM-blinded limbs (p=0.003). Freedom from AF and ATs with the non-irrigated catheter was 87.5% in the FIRM-guided and 42.1% in the FIRM-blinded limbs, while with the irrigated catheter was 58.3% and 25.0% respectively, thus meeting the criteria for non-inferiority. The figure shows arrhythmia-free survival in the FIRM-guided limb of the CONFIRM trial for irrigated and non-irrigated catheters.
Conclusions: The CONFIRM trial showed significantly improved ablation results with FIRM-guided ablation, independent of the use of irrigated or non-irrigated ablation catheters. Future studies should examine if similar outcomes are seen with other ablation energy sources such as cryoablation or high-frequency ultrasound.
- © 2012 by American Heart Association, Inc.