075 Significant Reduction in Microemboli During Pulmonary Vein Isolation With Multipolar Duty-Cycled Radiofrequency Pulmonary Vein Ablation Catheter Using the Modified Version of the GENius™ Generator

Abstract

BACKGROUND: Pulmonary vein isolation (PVI) techniques have been increasingly used to cure atrial fibrillation (AF). Recently, concerns have been raised that subclinical brain damage may occur due to microembolisation during these procedures, mostly when multipolar duty-cycled radiofrequency (RF) catheters (PVAC) are used. Technical modification of the GENiusTM 14.0 generator has been recently implemented to avoide high fluctuations in temperature at the electrode-tissue interface and to prevent overheating in order to reduce thrombus formation. We compared the occurence of microembolic signals (MES) detected by transcranial Doppler (TCD) which occured when the older GENiusTM 14.0 versus the modified GENiusTM 14.4 generator was used. METHODS/RESULTS: Data of 7 patients who had PVI for paroxysmal or persistent atrial fibrillation using the PVAC and the GENiusTM 14.0 generator were compared to those 10 who underwent the procedure using the GENiusTM 14.4 generator.There were no significant differences between the two groups regarding demographics, type of AF, CHADS2-score, left atrial size, and intraoperative anticoagulation protocol. Transcranial Doppler was used to detect MESs in middle cerebral arteries (MCA) in different stages of the procedures as follows: transseptal puncture (TP), pulmonary vein angiography (PVA), energy delivery (ED), and the rest of the porcedure (ROP). Mean total number of MESs during the procedures were 4766/ MCA SD:855 with the use of the GENiusTM 14.0 generator versus 1100/MCA SD:343with the GENiusTM 14.4 (p 0.001). Difference in the total number of MES was due to the difference in MES count detected during energy delivery period, while no difference was observed during the other stages of the procedures (figure 1). CONCLUSION: Significant reduction in the number of MES was achieved with the modified version of the GENiusTM generator during PVI. Canadian Cardiovascular Society (CCS) CCS033 Poster PRECLINICAL AND CLINICAL STUDIES IN HYPERTENSION Sunday, October 28, 2012