Efficacy and safety of a novel diamond tip temperature-controlled catheter for left atrial posterior wall isolation under electrogram guidance.

Background: The effectiveness of a novel diamond tip temperature-controlled ablation (DTA) catheter for left atrial posterior wall isolation (LAPWI) remains unclear.

Objective: This study evaluated the efficacy and safety of the DTA catheter for LAPWI under electrogram (EGM) guidance.

Methods: This single-center observational study compared the first-pass LAPWI success rate among three groups: DTA with EGM guidance (n = 82), conventional irrigation catheter with EGM guidance (Irri with EGM guidance; n = 92), and Irri without EGM guidance (n = 93), using fixed energy parameters (30 W, 15-20 s).

Results: DTA with EGM guidance had a significantly higher incidence of first-pass LAPWI success (93%, 76/82) than that of Irri without EGM guidance (54%; 50/93) (p < 0.001) and had a success rate comparable to that of the Irri with EGM guidance (97%; 89/92). Post hoc Bonferroni analysis demonstrated that the DTA with EGM guidance group had a significantly shorter radiofrequency-energy delivery duration (158 ± 63 s) than that of the Irri with EGM guidance group (229 ± 131 s; p < 0.0001) and the Irri without EGM guidance group (243 ± 185 s; p < 0.001). The DTA with EGM guidance group had a higher average RF power (45.1 ± 5.6 W) than the Irri with (31.2 ± 2.2 W; p < 0.0001) and without EGM guidance groups (28.0 ± 8.9 W; p < 0.001). No significant complications were observed.

Conclusions: The novel DTA catheter with EGM guidance achieved a high first-pass LAPWI success rate. The novel DTA catheter with short energy delivery and high average radiofrequency (RF) energy delivery under EGM guidance can be effectively applied in LAPWI.