Contact-Force-Sensing-Based Radiofrequency Catheter Ablation in Paroxysmal Supraventricular Tachycardias (COBRA-PATH): a randomized controlled trial

Abstract

Background: Multiple studies have demonstrated the importance of adequate catheter-tissue contact in the creation of effective lesions during radiofrequency catheter ablation. The development of contact force (CF)-sensing catheters has contributed significantly to improve clinical outcomes in atrial fibrillation. However, CF-sensing technology is not used in the ablation of paroxysmal supraventricular tachycardia (PSVT). The possible reason for this is that PSVT ablation with the conventional approach (i.e. nonirrigated, non-CF-sensing catheters) is considered a relatively low-risk procedure with fairly high success rates (short and long term). The aim of this study is to determine whether CF sensing can further improve the outcomes of PSVT ablation. Methods/design: The COBRA-PATH study is a single-center, two-armed, randomized controlled trial. Patients without structural heart disease being referred for electrophysiology study, because of PSVT and potential treatment with radiofrequency (RF) catheter ablation, will be randomly assigned to either manual ablation with standard nonirrigated ablation catheters or manual ablation with an open-irrigated ablation catheter equipped with CF sensing (used in a virtual nonirrigated modus). The primary study endpoint is the difference in the number of RF applications during the ablation of atrioventricular nodal re-entry tachycardia, and that of Wolff-Parkinson-White syndrome and atrioventricular re-entrant tachycardia. Secondary outcome parameters include acute and long-term procedural success rates, overall duration of RF applications, procedure/fluoroscopy durations and safety parameters.

Role of oesophageal cooling in the prevention of oesophageal injury in atrial fibrillation catheter ablation: a systematic review and meta-analysis of randomized controlled trials

“…For example, the use of contact force technology can provide real-time feedback for catheter tissue contact and, hence, could contribute to better safety and effectiveness of ablation. 35 Also, the use of techniques such as high-power/short-duration ablation can achieve superior ablation lesions, without increasing the risk of thermal injury. 36 , 37 Our analysis was limited by the variation in ablation techniques among the included studies, and further clinical trials are warranted to evaluate the role of oesophageal cooling among various ablation techniques.…”

Deep-Learning-Based Detection of Paroxysmal Supraventricular Tachycardia Using Sinus-Rhythm Electrocardiograms

“…Most patients with PSVT can be temporarily managed using physiological maneuvers, medications and occasionally even electrical cardioversion [ 5 ]. Catheter ablation is a permanent method for patients who want to cure the arrhythmia [ 8 ].…”

“…In the present study, the term “PSVT” mainly refers to atrioventricular nodal reentry tachycardia (AVNRT) or atrioventricular reentry tachycardia (AVRT) excluding atrial fibrillation, atrial flutter and atrial tachycardia. The occurrence of AVRT is based on an overt (Wolff–Parkinson–White (WPW) syndrome) or concealed accessory pathway [ 8 , 9 ]. A confirmatory diagnosis of PSVT can be made via electrocardiogram (ECG) or other rhythm-recording devices during tachycardia.…”