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Comparing rates of atrioesophageal fistula with contact force-sensing and non-contact force-sensing catheters: analysis of post-market safety surveillance data.

Authors
  • Calkins, Hugh1
  • Natale, Andrea2
  • Gomez, Tara3
  • Etlin, Alex3
  • Bishara, Moe4
  • 1 Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Sheikh Zayed Tower 7125R, Baltimore, MD, USA.
  • 2 Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. I-35, Suite 720, Austin, TX, 78705, USA.
  • 3 Biosense Webster Inc., 33 Technology Dr, Irvine, CA, 92618, USA.
  • 4 Biosense Webster Inc., 33 Technology Dr, Irvine, CA, 92618, USA. [email protected]
Type
Published Article
Journal
Journal of Interventional Cardiac Electrophysiology
Publisher
Springer-Verlag
Publication Date
Oct 01, 2020
Volume
59
Issue
1
Pages
49–55
Identifiers
DOI: 10.1007/s10840-019-00653-5
PMID: 31758505
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

There is limited data on the specific incidence of serious adverse events, such as atrioesophageal fistula (AEF), associated with either contact force (CF) or non-CF ablation catheters. Since the actual number of procedures performed with each type of catheter is unknown, making direct comparisons is difficult. The purpose of this study was to assess the incidence of AEF associated with the use of CF and non-CF catheters. Additionally, we aimed to understand the workflow present in confirmed AEF cases voluntarily provided by physicians. The number of AEFs for 2014-2017 associated with each type of catheter was extracted from an ablation device manufacturer's complaint database. Proprietary device sales data, a proxy for the total number of procedures, were used as the denominator to calculate the incidence rates. Additional survey and workflow data were systematically reviewed. Both CF and non-CF ablation catheters have comparably low incidence of AEF (0.006 ± 0.003% and 0.005 ± 0.003%, respectively, p = 0.69). CF catheters are the catheter of choice for left atrium (LA) procedures which pose the greatest risk for AEF injury. Retrospective analysis of seven AEF cases demonstrated that high power and force and long RF duration were delivered on the posterior wall of the left atrium in all cases. CF and non-CF ablation catheters were found to have similar AEF incidence, despite CF catheters being the catheter of choice for LA procedures. More investigation is needed to understand the range of parameters which may create risk for AEF.

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