Comparison of cooled-tip versus 4-mm-tip catheter in the efficacy of acute ablative tissue injury during circumferential pulmonary vein isolation

Shih Lin Chang, Ching Tai Tai, Yenn Jiang Lin, Li Wei Lo, Ta Chuan Tuan, Ameya R. Udyavar, Yu Feng Hu, Hsuan Ming Tsao, Chien Jun Chang, Wen Chin Tsai, Shih Ann Chen*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Cooled and 4-mm Tip in CPVI. Introduction: Although several studies have reported the benefits of cooled-tip ablation for circumferential pulmonary veins isolation (CPVI), the acute change of substrate property and acute PV reconnection have not been well demonstrated. The aim of this study was to compare the cooled-tip with regular 4-mm-tip catheter in acute substrate change after CPVI and long-term efficacy. Methods and Results: One hundred and fifty-six patients (115 males, age 53 ± 12 years) who underwent CPVI for treatment of atrial fibrillation (AF) were included. Group A consisted of 52 patients with cooled-tip ablation, and group B consisted of 104 patients with 4-mm-tip catheter ablation. The bipolar voltage of circumferential lesions was obtained using a 3-dimensional (3D) mapping system (NavX) before and after CPVI. The electrical reconnections of 4 PVs were evaluated 30 minutes after CPVI using a circular catheter. Cooled-tip catheter caused more reduction of the electrical voltage in PV antrum, lower incidence of acute PV reconnection, inducibility of AF, and gap-related atrial tachyarrhythmia (AT). Less number of left atrial (LA) ablation line and ablation applications and less procedure time were found in cooled-tip group compared to 4-mm-tip group. No significant difference in the incidence of pain sensation and complication was observed between the 2 groups. At a 14-month follow-up, the recurrence rate in the cooled-tip group was lower than in the 4-mm group (13.5% vs 33.7%, P = 0.009). Conclusion: Cooled-tip catheter has a superior long-term outcome than the 4-mm-tip catheter in CPVI, which may be associated with the efficacy of transmural block and electrical isolation in PV antrum.

Original languageEnglish
Pages (from-to)1113-1118
Number of pages6
JournalJournal of cardiovascular electrophysiology
Issue number10
StatePublished - 2009


  • Atrial fibrillation
  • Catheter ablation
  • Cooled tip
  • Electroanatomical mapping
  • Pulmonary vein


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