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Updated: Aug 6, 2026
Cooling or Warming the Esophagus to Reduce Esophageal Injury During Left Atrial Ablation in the Treatment of Atrial Fibrillation
Published on: March 15, 2020
Evaluation of the Impact of Irrigation Flow Rate on Clinical Outcomes During Pulsed Field Ablation
Kennosuke Yamashita1, Yohei Kikuchi1, Keita Yoshiyama1
1Heart Rhythm Center, Department of Cardiovascular Medicine, Sendai Kosei Hospital, Miyagi, Japan.
Introduction:
This prospective, non-randomized study assessed the impact of irrigation flow rates on silent cerebral events (SCEs) during pulsed field ablation (PFA) using the VARIPULSE catheter.
Methods:
Twenty patients underwent pulmonary vein isolation with either 4 mL/min (l-group) or 30 mL/min (H-group) irrigation.
Results:
SCEs occurred in 2/10 patients in the l-group and 0/10 in the H-group. Given the small sample and rare events, we report descriptive estimates with exact (Clopper-Pearson) 95% CIs (l-group 20.0% [95% CI: 2.5-55.6]; H-group 0.0% [95% CI: 0.0-30.9]) and a Newcombe (Wilson) 95% CI for the risk difference ( - 20.0% [95% CI: - 51.0 to +22.1]); no hypothesis testing was performed for SCEs. Despite a larger irrigation volume in the H-group, no hemodynamic worsening was observed.
Conclusion:
In this exploratory series, SCEs were not observed with 30 mL/min irrigation, but the study is underpowered to determine comparative safety.
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