Key result
Low-flow irrigated ablation (2 ml/min) provided favorable lesion characteristics for posterior left atrial ablation compared to high-flow (17 ml/min) without increasing adverse events (p<0.05).
Why the study?
Does low-flow irrigated ablation improve lesion characteristics without increasing adverse events compared to high-flow ablation in thin atrial tissue?
Observational (n=386)
Does low-flow irrigated ablation improve lesion characteristics without increasing adverse events compared to high-flow ablation in thin atrial tissue?
Low-flow irrigated ablation creates favorable transmural lesions in thin atrial tissue without increasing the risk of adverse events compared to high-flow ablation.
May support low-flow irrigation for posterior LA lesions without added risk; hypothesis-generating for clinical outcomes.
OBJECTIVES: The authors sought to investigate the effect of low irrigation flow rate on lesion characteristics and ablation outcomes in a clinicopathological study. BACKGROUND: Irrigated ablation produces deeper lesions compared with nonirrigated ablation, which may not be desirable in the thin-walled posterior left atrium (LA), where collateral esophageal injury is possible. METHODS: Lesions were placed on the smooth posterior right atrium in 20 swine and posterior LA in 60 patients at a maximum power of 20 to 25 W with either: 1) power-controlled ablation at an irrigation flow rate of 17 ml/min (high-flow group 10 swine; n = 40) or 2) temperature-controlled ablation at an irrigation flow rate of 2 ml/min (low-flow group 10 swine; n = 20). Safety and efficacy was also compared in 326 patients undergoing AF ablation using high-flow (n = 160) or low-flow settings (n = 166) for posterior LA ablation. RESULTS: Low-flow, compared with high-flow, lesions in swine had a higher incidence of lesions with: impedance fall ≥10 Ω, loss of pace capture, electrograms characteristic of transmural lesions, and visible lesions on anatomic inspection (p < 0.05 for all). Low-flow lesions had a maximal diameter at the endocardial surface, whereas high-flow lesions had a maximal diameter at the epicardial surface. In humans, impedance, pace capture, and transmurality data also strongly favored low-flow lesions. There was no difference in acute pulmonary vein isolation, complications, or 12-month arrhythmia-free survival between the groups. CONCLUSIONS: Low-flow irrigated ablation provides favorable lesion characteristics for posterior LA ablation without increasing the risk of adverse events.
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Kumar et al. (2017) conducted an observational in Atrial Fibrillation (n=386). Low-flow irrigated ablation vs. High-flow irrigated ablation (17 ml/min) was evaluated on Lesion characteristics (impedance fall ≥10 Ω, loss of pace capture, transmurality) and 12-month arrhythmia-free survival (p=<0.05). Low-flow irrigated ablation (2 ml/min) provided favorable lesion characteristics for posterior left atrial ablation compared to high-flow (17 ml/min) without increasing adverse events (p<0.05).
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