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2025 AF Symposium
Live Case Transmission: RF/PFA Ablation Using the TactiFlex Duo System
Dr. Larry Chinitz
A live case transmission (Session 4) is always a big draw at the AF Symposium! Dr. Moussa Mansour introduced Dr. Larry Chinitz and moderated the ablation presentation.
Dr. Chinitz from NYU Langone Medical Center in New York, NY presented a live case using Abbott’s TactiFlex RF/PFA catheter, entitled “TactiFlex Duo Dual Modality RF/PFA Ablation for PAF—the FlexPulse IDE Trial.”
Live From New York It’s Friday Morning!!!
Dr. Chinitz had fun introducing his talk with a reference to NBC’s Saturday Night LIVE’s opening.
Ablation power sources: RF=Radio-Frequency; PFA=Pulsed Field Ablation
His patient was a 79-year-old male with a 20-year history of A-Fib who had never been ablated before. He had both AF and Flutter and had been cardioverted several times. Over the last year his episodes had increased substantially. He was under general anesthesia and paralyzed. Jet ventilation was used to reduce heart movement.
Abbott’s TactiFlex RF/PFA catheter
TactiFlex Dual Energy Catheter
Dr. Chinitz used the Abbott dual energy system (with RF and PFA energies) with the TactiFlex Duo Ablation Catheter, SE (Sensor Enabled) system.
When needed, the Electrophysiologist (EP) simply toggles between the two energy sources during the ablation.
The TactiFlex irrigated catheter has a flexible curved tip with 56 holes and uses a fiber optical control system. Its tip size is 4mm. It is fully integrated with the Abbott EnSite X EP mapping system. It incorporates contact force sensing with an arrow indicating deflection direction.
Abbott EnSite X EP mapping system
RF for Cavotricuspid Isthmus (CTI) Ablation
Before Dr. Chinitz began his live case, he and his colleagues in the Electrophysiology (EP) lab had already done an RF ablation of the Cavotricuspid Isthmus [a critical area in the lower right atrium] using high power short duration pulses (40 watt 15 seconds).
Dr. Chinitz explained that he uses RF energy for Flutter, for CTI ablation, and when ablating near the coronary arteries.
Pulse Field Ablation for the Left Atrium
Dr. Chinitz used Pulse Field Ablation (PFA) to ablate the Left Atrium.
Normally a toggle would be used to switch from RF to PFA energy. But in this particular case study, Dr. Chinitz had to call on an Abbott technician/rep to make the change.
Dr. Chinitz used unipolar biphasic PFA 40 watts for 15 seconds with only one application.
As he made his PFA applications, a blue dot would appear on the EnSite monitor to signify a good lesion. White dots would indicate contact force lesions less than 10 grams which needed to be stronger. Each lesion was made up of 5 pulses over 4 seconds duration.
A-Fib/Sinus Rhythm Fluctuated During Procedure
PFA was used to isolate the Pulmonary Veins (PVs). But during the procedure the patient went back and forth from A-Fib to normal sinus rhythm and had to be cardioverted several times.
Dr. Chinitz switched to RF to ablate near the annulus [fibrous ring at the base of a heart valve] and the coronary arteries. The patient remained in tachycardia which they terminated by ablating the posterior wall.
As the allotted time at the AF Symposium in Boston ran out, there was still more ablation tasks to perform in the New York EP lab. Dr. Chinitz said he will use isoproterenol to check for other arrhythmia.
Editor’s Comments
Editor’s CommentsRF Isn’t Dead! EPs have been using RF energy for catheter ablations for years. I predict that not only veteran EPs, but also newer operators will welcome the dual energy of RF and PFA using the TactiFlex catheter and the options it offers.
A live case is always exciting to watch and listen in on.
What A-Fib Patients Need to Know: Being able to use both RF and PFA energy during an ablation gives the EP more options.
But even without a Duo Dual Modality RF/PFA system, switching to RF energy isn’t a problem. EP labs, in general, are equipped with a standard RF energy ablation system. So if an EP is using a PFA system and if RF energy is needed, they can simply change to an RF catheter and continue with an RF system.
Therefore, if an A-Fib patient is undergoing a Pulsed Field Ablation, it isn’t necessary to find a center using a dual energy catheter.
