Porous tip radiofrequency ablation catheter reduced heart failure-related complications and healthcare resource utilization in paroxysmal atrial fibrillation patients

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Introduction: A 56-hole porous tip radiofrequency catheter was developed to provide more uniform cooling with less fluid delivery than a prior 6-hole irrigated design. This study aimed to evaluate the impact of contact force (CF) ablation with the porous tip on complications (congestive heart failure [CHF] and non-CHF related), healthcare resource utilization, and procedural efficiency in patients undergoing de novo paroxysmal atrial fibrillation (PAF) ablations in a real-world setting. Methods: Consecutive de novo PAF ablations were performed between February 2014 and March 2019 by six operators at a single US academic center. The 6-hole design was used through December 2016 with the 56-hole porous tip adopted in October 2016. The outcomes of interest included symptomatic CHF presentation and CHF-related complications. Results: Of 174 patients who were included, mean age was 61.1 ± 10.8 years, 67.8% were male, and 25.3% had a history of CHF. Ablation with the porous tip catheter significantly decreased fluid delivery (1177 vs. 1912 mL with the 6-hole design; p <.0001). CHF-related complications within 7 days, particularly fluid overload, were substantially reduced with the porous tip (15.2% vs. 5.3% of patients; p =.0281) and the proportion of patients with symptomatic CHF presentation within 30 days postablation was significantly lower (14.7% vs. 32.5%; p =.0058). Conclusion: The 56-hole porous tip led to significantly reduced CHF-related complications and healthcare utilization in PAF patients undergoing CF catheter ablation when compared to the prior 6-hole design. This reduction likely results from the significant decrease in fluid delivery during the procedure.