Arrhythmias & electrophysiologyMechanistic study
Impact of saline irrigation on haemolysis, silent cerebral lesion incidence, thermal dynamics, and bubble formation in pulsed field ablation with a variable-loop circular catheter
- Mechanistic study
- ex-vivo potato model
- in vitro blood pool and cardiac ablation
- in vivo swine ablation
- clinical randomized trial
Authors' conclusion
Proper saline irrigation during PFA with VLCC may mitigate electrode-associated haemolysis, reduce electrode and tissue temperature, limit bubble aggregation, and be associated with a lower incidence of silent cerebral lesions, the clinical significance of which remains unclear.
Study context
- Population
- Pulsed-field ablation (PFA) with a variable-loop circular catheter (VLCC): ex-vivo, in vitro, swine and clinical modelsswine n = 8
- Comparison
- High-flow irrigation vs Low-flow irrigation
Main finding
As reported in the abstract
Silent cerebral lesions (clinical RCT)
P = 0.036
Further findings
Lesion depth (ex vivo potato)
P = 0.043
| Outcome | High-flow irrigation | Low-flow irrigation | P value |
|---|---|---|---|
| Total number of gaseous bubbles · larger bubbles eliminated with high flow | 54.50 (IQR 53.00–56.75) | 82.00 (IQR 72.00–83.00) | P < 0.001 |
Safety
Silent cerebral lesions (clinical trial)
P = 0.036
Acute cerebral lesion (swine)
- One swine in the low-irrigation group developed an acute cerebral lesion (3 mm)
- 1
Original publication
Impact of saline irrigation on haemolysis, silent cerebral lesion incidence, thermal dynamics, and bubble formation in pulsed field ablation with a variable-loop circular catheter. Europace. Published 13 January 2026. doi:10.1093/europace/euag005
Summarised from the published abstract; every number is checked against it