Cooled ablation reduces pulmonary vein isolation time: results of a prospective randomised trial.
BACKGROUND
Currently, selection of the ablation catheter for pulmonary vein (PV) isolation is a matter of choice.


OBJECTIVE
To evaluate the efficiency of cooled ablation for PV isolation.


METHODS
A prospective randomised trial was carried out comparing the time required to disconnect each targeted PV using cooled ablation (open irrigation at 15 ml/min, group A) or standard temperature-controlled 4 mm tip catheter ablation (group B). The ablation parameter limit settings were 45 degrees C, 35 (5) W in group A, and 55 degrees C, 35 (5) W in group B.


RESULTS
Thirty-six patients referred for a first atrial fibrillation (AF) ablation procedure were randomised to group A or group B (18 patients in each group). There were no significant differences in baseline characteristics between the groups. Bidirectional block was achieved in 61/61 PVs from group A (100%) and 59/61 PVs from group B (97%); p = NS. Time to PV disconnection was significantly shorter in group A than in group B (median (25th-75th centiles) 14 (5-28) min vs 19 (14-32) min, respectively; p = 0.003). Five asymptomatic PV stenoses were identified by MRI, all in group B (p = 0.05). After 1-year minimum follow-up, AF recurrences were less frequently documented in patients treated with cooled ablation (6% vs 33%; p = 0.05).


CONCLUSIONS
Cooled ablation is more efficient than standard ablation in achieving PV isolation. Results obtained from this study also suggest a potential benefit of clinical efficacy and safety from cooled ablation, which should be further evaluated in larger clinical trials.
Pérez-Castellano
N
N
Unit of Arrhythmias, Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain. nperez.hcsc@salud.madrid.org
Villacastin
J
J
Salinas
J
J
Moreno
J
J
Doblado
M
M
Ruiz
E
E
Isa
R
R
Macaya
C
C
D000328:Adult; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation*; D003080:Cold Temperature; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D055502:Secondary Prevention; D013997:Time Factors; D016896:Treatment Outcome