Impact of ablation catheter irrigation design on silent cerebral embolism after radiofrequency catheter ablation of atrial fibrillation: results from a pilot study

J Cardiovasc Electrophysiol. 2012 Aug;23(8):801-5. doi: 10.1111/j.1540-8167.2012.02298.x. Epub 2012 Apr 11.


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.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Asymptomatic Diseases
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / physiopathology
  • Atrial Fibrillation / surgery*
  • Cardiac Catheters*
  • Catheter Ablation / adverse effects
  • Catheter Ablation / instrumentation*
  • Chi-Square Distribution
  • Equipment Design
  • Female
  • Humans
  • Incidence
  • Intracranial Embolism / diagnosis
  • Intracranial Embolism / epidemiology
  • Intracranial Embolism / prevention & control*
  • Italy / epidemiology
  • Logistic Models
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Pilot Projects
  • Prospective Studies
  • Pulmonary Veins / physiopathology
  • Pulmonary Veins / surgery*
  • Risk Assessment
  • Risk Factors
  • Sodium Chloride / administration & dosage
  • Therapeutic Irrigation / adverse effects
  • Therapeutic Irrigation / instrumentation*
  • Time Factors
  • Treatment Outcome


  • Sodium Chloride