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Cooled Ablation Reduces Pulmonary Vein Isolation Time: Results of a Prospective Randomised Trial
  1. Nicasio Perez-Castellano (nperez.hcsc{at}salud.madrid.org)
  1. San Carlos University Hospital, Spain
    1. Julian Villacastin (jvillacastin{at}secardiologia.es)
    1. San Carlos University Hospital, Spain
      1. Jorge Salinas (docsalinas2004{at}yahoo.com)
      1. San Carlos University Hospital, Spain
        1. Javier Moreno (jmoreno{at}secardiologia.es)
        1. San Carlos University Hospital, Spain
          1. Manuel Doblado (dobladombe{at}hotmail.com)
          1. San Carlos University Hospital, Spain
            1. Eduardo Ruiz (edruhdz{at}gmail.com)
            1. San Carlos University Hospital, Spain
              1. Rodrigo Isa (rodrigo_isa{at}hotmail.com)
              1. San Carlos University Hospital, Spain
                1. Carlos Macaya (cmacaya.hcsc{at}salud.madrid.org)
                1. San Carlos University Hospital, Spain

                  Abstract

                  Objective Currently, the selection of the ablation catheter for pulmonary vein (PV) isolation is a matter of choice. The aim of this study was to evaluate the efficiency of cooled ablation for PV isolation.

                  Methods This was a prospective randomised trial 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). 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 by group). There were no significant differences in baseline characteristics between both groups. Bidirectional block was achieved in 61 of 61 PVs from group A (100%) and 59 of 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 percentiles] = 14 [5 - 28] min vs 19 [14 - 32] min, respectively; P=0.003). Five asymptomatic PV stenoses were identified by MRI, all of them 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 in some issues regarding clinical efficacy and safety, which should be further evaluated in larger clinical trials.

                  • atrial fibrillation
                  • catheter ablation
                  • clinical trial
                  • pulmonary vein

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