ORIGINAL ARTICLES

Cooled ablation reduces pulmonary vein isolation time: results of a prospective randomised trial

N Pérez-Castellano, J Villacastin, J Salinas, J Moreno, M Doblado, E Ruiz, R Isa, C Macaya

Unit of Arrhythmias, Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain

Dr N Pérez-Castellano, Unidad de Arritmias, Instituto Cardiovascular, Hospital Clínico San Carlos, C/ Professor Martín Lagos s/n, 28040 Madrid, Spain; nperez.hcsc{at}salud.madrid.org

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°C, 35 (5) W in group A, and 55°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).

Conclusion: 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.

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