title: Impact of ablation catheter irrigation design on silent cerebral embolism after radiofrequency catheter ablation of atrial fibrillation: results from a pilot study.
abstract: BACKGROUND
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Cardiology Division, Cardinal Guglielmo Massaia Hospital, Asti, Italy. marco.scaglione@tin.it
authors.forename: Marco
authors.initials: M
authors.lastname: Scaglione
authors.forename: Alessandro
authors.initials: A
authors.lastname: Blandino
authors.forename: Cristina
authors.initials: C
authors.lastname: Raimondo
authors.forename: Domenico
authors.initials: D
authors.lastname: Caponi
authors.forename: Paolo
authors.initials: P
authors.lastname: Di Donna
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Toso
authors.forename: Elisa
authors.initials: E
authors.lastname: Ebrille
authors.forename: Federico
authors.initials: F
authors.lastname: Cesarani
authors.forename: Eva
authors.initials: E
authors.lastname: Ferrarese
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D000328:Adult; D000368:Aged; D058070:Asymptomatic Diseases; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation*; D016009:Chi-Square Distribution; D004867:Equipment Design; D005260:Female; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010865:Pilot Projects; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D012965:Sodium Chloride / Q000008:administration & dosage; D007507:Therapeutic Irrigation / Q000009:adverse effects / Q000295:instrumentation*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D012965:Sodium Chloride