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Impact of Ablation Catheter Irrigation Design on Silent Cerebral Embolism After Radiofrequency Catheter Ablation of Atrial Fibrillation: Results from a Pilot Study
Author(s) -
SCAGLIONE MARCO,
BLANDINO ALESSANDRO,
RAIMONDO CRISTINA,
CAPONI DOMENICO,
Di DONNA PAOLO,
TOSO ELISABETTA,
EBRILLE ELISA,
CESARANI FEDERICO,
FERRARESE EVA,
GAITA FIORENZO
Publication year - 2012
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2012.02298.x
Subject(s) - medicine , catheter , catheter ablation , atrial fibrillation , ablation , thrombus , saline , cardiology , surgery , anesthesia
Catheter Design and Anticoagulation on Postablation Silent Cerebral Ischemia. Introduction: Silent cerebral lesions (SCL) are a sensitive tool to evaluate thromboembolic risk of catheter ablation. Recent data showed the possibility to reduce thrombus formation when the electrode–tissue interface cooling is optimized by a homogeneous flushing of saline along the entire surface of the distal electrode through a larger number of irrigation holes. The study aim is to compare procedural parameters and safety of pulmonary vein isolation (PVI) performed by using open‐irrigated catheters with different irrigation design.Methods and Results:Eighty patients (74% males; age 57 ± 12 years) with paroxysmal AF randomly underwent PVI performed with a new irrigation design catheter (group A, 40 patients) versus a standard irrigated catheter (group B, 40 patients). A cerebral magnetic resonance imaging (MRI) was performed before and after the procedure. Postprocedural brain MRI unveiled SCL in 2 patients in group A and in 3 in group B (5% vs 7.5%, P = 0.500). Intraprocedural ACT was the only independent factor associated with the occurrence of SCL (OR = 0.996; 95% CI 0.994–0.998, P < 0.001). Among procedural parameters, we observed a reduction of irrigation saline volume of 662 mL in group A versus group B (P < 0.001).Conclusion:PVI performed with a new irrigated catheter did not reduce significantly the SCL risk when compared to a standard irrigated catheter. Intraprocedural ACT reduces the SCL risk of 0.4% for each point of ACT increase. For ACT > 320 seconds no SCL occurred. Finally, compared to a standard irrigated catheter, PVI performed with a new irrigation design catheter reduces significantly saline volume infusion. (J Cardiovasc Electrophysiol, Vol. 23, pp. 801‐805, August 2012)