Effect of preventing air intrusion on silent strokes during atrial fibrillation ablation using a mini‐basket catheter

Abstract

Background Air bubble intrusion through transseptal sheaths during left atrial (LA) catheter ablation can cause cerebral embolisms, especially when using complex‐shape catheters. This study aimed to compare the incidence of silent cerebral events (SCEs) after atrial fibrillation (AF) catheter ablation using a mini‐basket catheter (IntellaMap Orion; Boston Scientific) between the following groups: group SP, strict prevention of LA air intrusion and group CP, conventional air intrusion prevention. Methods We enrolled 123 consecutive AF patients (group SP, n = 61 and group CP, n = 62) who underwent brain magnetic resonance imaging after a local‐impedance‐guided ablation using one mini‐basket catheter and one circular mapping catheter. The preventive strategy in group SP included (a) the insertion of the mini‐basket catheter into the transseptal sheaths in a container filled with heparinized saline and (b) no exchange of all catheters over the sheaths. Results SCEs were detected in 67 patients (54.5%), and the incidence of SCEs did not significantly differ between groups SP and CP (55.7% vs 53.2%; P = .780). A multivariate analysis demonstrated that an older age, non‐paroxysmal AF, and radiofrequency (RF) power output were independent positive predictors of SCEs (odds ratios: 1.079, 5.613, and 1.405; P = .005, <.001, and .012). On the follow‐up MR imaging, 83.5% of the SCEs in group SP and 87.7% in group CP disappeared (P = .398). Conclusions Strict prevention of LA air intrusion may have no additional effect for reducing the incidence of SCEs after local impedance‐guided AF ablation using a mini‐basket catheter. An older age, non‐paroxysmal AF, and high‐power RF applications may increase the risk of SCEs.

Atrial fibrillation catheter ablation associated silent cerebral emboli: A narrative review

“…Other than the abovementioned device-related factors, additional risk factors related to SCE exist at the procedural level as well as at the patient level. The reported risk factors of AFCA-related SCE included an older age, 20,28,[59][60][61][62] lower ACT value, 61,63,64 ablation of complex fractionated atrial electrogram (CFAE), 20 periprocedural cardioversion, 11,12,20,63,[65][66][67] CHADS 2 /CHA 2 DS 2 -VASc score, 40,61,64 concomitant coronary angiography, 68,69 lower left ventricular ejection fraction (LVEF), 12,68,70 left atrial dimension, 61,65,71 non-paroxysmal AF, 20,61,65,70,[72][73][74] and spontaneous echocardiographic contrast (SEC) in transesophageal echocardiography (TEE) examination. 20,65 On an intuitive level, the risk of SCE should be elevated in the elderly, non-PAF patients, and patients with SEC, lower LVEF, or higher CHADS2/CHA2DS2-VASc scores, but previous studies had not reached consistent conclusions.…”

“…24 Yet, the majority of studies had not determined the association between extensive ablation and SCE. 6,23,[62][63][64]70,71,78,[88][89] The exact impact of extensive ablation on SCE is still under debate. High power RF application is also considered one of the risk factors for SCE.…”

“…High power RF application is also considered one of the risk factors for SCE. 62 An animal study by Takami et al showed that ablation with 50-W was more likely to produce microparticles than ablation with 30-W. 31…”

“…In addition, the need for touch‐up ablation with the irrigated RF catheter during cryoablation could predict the occurrence of SCE 24 . Yet, the majority of studies had not determined the association between extensive ablation and SCE 6,23,62–64,70,71,78,88–89 . The exact impact of extensive ablation on SCE is still under debate.…”

“…The exact impact of extensive ablation on SCE is still under debate. High power RF application is also considered one of the risk factors for SCE 62 . An animal study by Takami et al.…”