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Incidence of asymptomatic intracranial embolic events after pulmonary vein isolation: comparison of different atrial fibrillation ablation technologies in a multicenter study.

Abstract：

OBJECTIVES:We compared the safety of different devices by screening for subclinical intracranial embolic events after pulmonary vein isolation with either conventional irrigated radiofrequency (RF) or cryoballoon or multielectrode phased RF pulmonary vein ablation catheter (PVAC). BACKGROUND:New devices specifically designed to facilitate pulmonary vein isolation procedures have recently been introduced. METHODS:This prospective, observational, multicenter study included patients with symptomatic atrial fibrillation referred for pulmonary vein isolation. Ablation was performed using 1 of the 3 catheters. Strict periprocedural anticoagulation, with intravenous heparin during ablation to achieve an activated clotting time >300 s, was ensured in all patients. Cerebral magnetic resonance imaging was performed before and after ablation. RESULTS:Seventy-four patients were included in the study: 27 in the irrigated RF group, 23 in the cryoballoon group, and 24 in the PVAC group. Total procedure times were 198 ± 50 min, 174 ± 35 min, and 124 ± 32 min, respectively (p < 0.001 for PVAC vs. irrigated RF and cryoballoon). Findings on neurological examination were normal in all patients before and after ablation. Post-procedure magnetic resonance imaging detected a single new embolic lesion in 2 of 27 patients in the irrigated RF group (7.4%) and in 1 of 23 in the cryoballoon group (4.3%). However, in the PVAC group 9 of 24 patients (37.5%) demonstrated 2.7 ± 1.3 new lesions each (p = 0.003 for the presence of new embolic events among the 3 groups). CONCLUSIONS:The PVAC is associated with a significantly higher incidence of subclinical intracranial embolic events. Further study of the causes and significance of these emboli is required to determine the safety of the PVAC.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Herrera Siklódy C,Deneke T,Hocini M,Lehrmann H,Shin DI,Miyazaki S,Henschke S,Fluegel P,Schiebeling-Römer J,Bansmann PM,Bourdias T,Dousset V,Haïssaguerre M,Arentz T

doi

10.1016/j.jacc.2011.04.010

subject

Has Abstract

pub_date

2011-08-09 00:00:00

pages

681-8

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(11)01545-2

journal_volume

pub_type

杂志文章,多中心研究

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Incidence of asymptomatic intracranial embolic events after pulmonary vein isolation: comparison of different atrial fibrillation ablation technologies in a multicenter study.