Clinical Research
Clinical Trial
Incidence of Asymptomatic Intracranial Embolic Events After Pulmonary Vein Isolation: Comparison of Different Atrial Fibrillation Ablation Technologies in a Multicenter Study

https://doi.org/10.1016/j.jacc.2011.04.010Get rights and content
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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.

Key Words

atrial fibrillation
catheter ablation
embolic events
magnetic resonance imaging

Abbreviations and Acronyms

ACT
activated clotting time
AF
atrial fibrillation
INR
international normalized ratio
LA
left atrium
MRI
magnetic resonance imaging
PV
pulmonary vein
PVAC
multielectrode duty-cycled radiofrequency pulmonary vein ablation catheter
PVI
pulmonary vein isolation
RF
radiofrequency
TEE
transesophageal echocardiography

Cited by (0)

Dr. Herrera Siklódy has received consulting and speaker honoraria from Medtronic and speaker honoraria from Biosense Webster. Dr. Hocini has received speaker honoraria from Biosense Webster. Dr. Miyazaki has received fellowship support from St. Jude Medical. Dr. Schiebeling-Römer has received fellowship support from St. Jude Medical. Dr. Haïssaguerre has received speaker honoraria from Biosense Webster. Dr. Arentz has received consulting honoraria from Medtronic. All other authors have reported that they have no relationships to disclose.