Abstract 3225: Ablation Of The Pulmonary Veins Using An Irrigated Tip Rf Ablation Catheter Reduces Cerebral Microemboli Versus A Non-irrigated-tip Rf Ablation Catheter.
Background Pulmonary vein isolation (PVI) has become an established treatment for patients with atrial fibrillation (AF). But post-intervention complications like, TIA, stroke and cognitive decline, might occur. In this study the incidence of microembolic signals (MES) was determined during percutaneous PVI; non-irrigated tip radiofrequency (RF) ablation versus irrigated tip RF ablation.
Methods and Results Twelve patients underwent PV catheter RF ablation. Two patient groups were selected; Group NON-IRRIGATED RF: a non-irrigated RF ablation catheter (temperature< 55°, power< 30 W) was used in 7 patients, Group IRRIGATED RF: an irrigated tip RF ablation catheter (temperature< 43°, power< 25 W) was used in 5 patients. Transcranial Doppler (TCD) was used to detect microembolic signals in the middle cerebral arteries. The duration of the procedure, the number of applications and the total ablation time was not different between both groups. In the IRRIGATED RF group versus the NON-IRRIGATED group less cerebral MES were detected during the complete procedure (1570 vs. 3515) and per 1 minute of ablation (4 vs.89).
Conclusions Ablation of the pulmonary veins in a percutaneous endocardial approach causes a significant number of cerebral MES during the procedure. The cerebral MES detected during ablation are most likely gas bubbles and solid emboli due to overheating of the tissue and blood. Because a positive association between the number of cerebral MES and the risk of stroke and neurological impairment has been reported, the RF irrigated tip ablation catheter might be preferable in an effort to reduce the stroke risk.