OBJECTIVES: This study sought to evaluate the safety and short-term performance of a novel catheter for very high power-short duration (vHPSD) ablation in the treatment of paroxysmal atrial fibrillation. BACKGROUND: The vHPSD catheter is a novel contact force-sensing catheter optimized for temperature-controlled radiofrequency ablation with microelectrodes and 6 thermocouples for real-time temperature monitoring; the associated vHPSD algorithm modulates power to maintain target temperature during 90 W, 4 s lesions. METHODS: QDOT-FAST (Clinical Study for Safety and Acute Performance Evaluation of the THERMOCOOL SMARTTOUCH SF-5D System Used With Fast Ablation Mode in Treatment of Patients With Paroxysmal Atrial Fibrillation) is a prospective, multicenter, single-arm study enrolling patients with symptomatic paroxysmal atrial fibrillation indicated for catheter-based pulmonary vein isolation. Primary endpoints were short-term effectiveness (confirmation of entrance block in all targeted pulmonary veins after adenosine/isoproterenol challenge) and short-term safety (primary adverse events). Participants were screened for silent cerebral lesions by magnetic resonance imaging. Patients were followed for 3 months post-ablation. RESULTS: A total of 52 patients underwent ablation and completed follow-up. Pulmonary vein isolation was achieved in all patients using the study catheter alone, with total procedure and fluoroscopy times of 105.2 ± 24.7 min and 6.6 ± 8.2 min, respectively. Most patients (n = 49; 94.2%) were in sinus rhythm at 3 months. Two primary adverse events were reported: 1 pseudoaneurysm; and 1 asymptomatic thromboembolism. There were no deaths, stroke, atrioesophageal fistula, pulmonary vein stenosis, or unanticipated adverse device effects. Six patients had identified silent cerebral lesions-all classified as asymptomatic without clinical or neurologic deficits. CONCLUSIONS: This first-in-human study of a novel catheter with optimized temperature control demonstrated the clinical feasibility and safety of vHPSD ablation. Procedure and fluoroscopy times were substantially lower than historical standard ablation with point-by-point catheters. (Clinical Study for Safety and Acute Performance Evaluation of the THERMOCOOL SMARTTOUCH SF-5D System Used With Fast Ablation Mode in Treatment of Patients With Paroxysmal Atrial Fibrillation [QDOT-FAST]; NCT03459196).

Cardiac Electrophysiology Icahn School of Medicine at Mount Sinai New York New York; Department of Cardiology Na Homolce Hospital Prague Czech Republic

Cardiovascular Center Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium

Department of Cardiology Algemeen Ziekenhuis Sint Jan Bruges Belgium

Department of Cardiology Ceske Budejovice Hospital Faculty of Health and Social Sciences University of South Bohemia in Ceske Budejovice Ceske Budejovice Czech Republic

Department of Cardiology Na Homolce Hospital Prague Czech Republic

Department of Cardiology Ordensklinikum Linz Elisabethinen Linz Austria

Department of Cardiology Ospedale Generale Regionale F Muilli Acquaviva delle Fonti Italy

Hasselt Heart Center Jessa Hospital Hasselt Belgium

Texas Cardiac Arrhythmia Institute St David's Medical Center Austin Texas

JACC Clin Electrophysiol. 2019 Jul;5(7):787-788. doi: 10.1016/j.jacep.2019.05.007. PubMed

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Temperature-Controlled Catheter Ablation for Paroxysmal Atrial Fibrillation: the QDOT-MICRO Workflow Sttudy

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ClinicalTrials.gov
NCT03459196