Risks and benefits of an open irrigation tip catheter in intensive radiofrequency catheter ablation in patients with non-paroxysmal atrial fibrillation

Background: Although open irrigation tip catheters (OITC) are effective in producing transmural radiofrequency (RF) lesions, they have the potential for fluid overload or excessive tissue damage. Methods and Results: The 203 patients with non-paroxysmal atrial fibrillation (NPAF; 85.2% males, 55.2±10.6 years old) who underwent RF catheter ablation (RFCA) were analyzed retrospectively. Clinical outcomes and complications were compared between RFCA using OITC (n=92) and that using conventional catheters (CONC; n=111). Both the total procedure time (P<0.01) and fluoroscopic time (P<0.001) were shorter in the OITC group than in the CONC group. Total fluid loading during RFCA with OITC was 3.2±0.9L, and the average body weight increase was 1.8±1.2 kg. Symptomatic pulmonary edema and/or pleural effusion occurred in 3.3% of patients who had a bigger left atrium (P=0.005), longer duration of ablation procedure (P=0.002), higher post-RFCA serum pro-ANP level (P<0.001), and longer hospitalization (P<0.01). Conclusions: RFCA for NPAF using OITC results in a shorter procedure time compared with CONC. However, patients with a large left atrium and a large amount of fluid (>4L) infused via the OITC need to be carefully monitored to prevent pulmonary edema or pleural effusion because of fluid overload.