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J Interv Card Electrophysiol. 2013 Jun;37(1):97-103. doi: 10.1007/s10840-012-9765-3. Epub 2013 Feb 9.

Clinical evaluation of a novel 12-hole irrigated tip catheter ablation system for the treatment of typical atrial flutter-results from the Duo FLAIR clinical study.

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  • 1Center for Excellence in Atrial Fibrillation and EP Research-KU Cardiovascular Research Institute, Bloch Heart Rhythm Center, Mid America Cardiology, University of Kansas Hospital and Medical Center, Kansas City, KS 66160, USA.



Higher current density at the proximal end of a six-hole catheter is not irrigated and thus could lead to uneven heating and possibly coagulum and charring. This study tested a novel 12-hole irrigated catheter with six additional holes at the proximal end that provides more uniform cooling during atrial flutter (AFL) ablation.


A total of 188 patients (28 females, 66 ± 11 years) were treated for typical AFL at 22 sites in the USA and Canada using Cool Path Duo at 50 W and 45 °C at an irrigation rate of 13 ml/min. The results were compared to historical data from an AFL study which used a six-hole catheter with similar design.


A total of 2,725 RF lesions were applied in 188 patients with a mean RF duration of 18.2 ± 11.7 min per procedure. Procedural success was achieved in 96.3 % (181 of 188) acutely and 98.3 % (173 of 176) patients at 3 months. Steam pops occurred in 0.6 % of lesions (15 of 2,725) without coagulum or charring… Compared to the six-hole irrigated tip catheter, the Cool Path Duo catheter delivered more power (33.8 ± 5.9 vs. 29.7 ± 5.2 W, p < 0.0001) at a lower average tip temperature (34.7 ± 1.5 vs. 37.2 ± 2.1 °C, p < 0.0001) with no statistical differences in either 3-month AFL recurrence or complications.


Cool Path Duo™ irrigated tip catheter is safe and effective in treating typical AFL. When compared to a six-hole irrigated tip catheter, the Cool Path Duo catheter delivers more power at a lower temperature.

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