Incidence and Clinical Significance of Cerebral Embolism During Atrial Fibrillation Ablation With Duty-Cycled Phased-Radiofrequency Versus Cooled-Radiofrequency

Keçe, Fehmi; Bruggemans, Eline F.; Riva, Marta; Dehnavi, Reza Alizadeh; Wijnmaalen, Adrianus P.; Meulman, Tamara J; Brugman, Julia A.; Rooijmans, Anouk M.; Buchem, Mark A. van; Middelkoop, Huub A. M.; Eikenboom, Jeroen; Schalij, Martin J.; Zeppenfeld, Katja; Trines, Serge A.

doi:10.1016/j.jacep.2018.11.008

Cited by 18 publications

(15 citation statements)

References 22 publications

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“…The distribution of factors potentially related to thromboembolic risk (comorbidities, LA diameter, persistent form of AF) was well balanced between the groups (Table I). Arterial hypertension was the most frequent comorbidity in all groups, which is consistent with other observations regarding the AF population [23][24][25][26][27]. The ablation procedure was performed with irrigated radiofrequency point-by-point technique (RF group) in 24 patients, and with 3 different single-shot techniques: a non-irrigated duty-cycled phased-RF catheter (PVAC) in 46 patients, a second-generation cryoballoon (CB) in 24 patients and with an irrigated multipolar RF catheter (nMARQ) in 10 patients.…”

Section: Study Populationsupporting

confidence: 91%

“…This phenomenon, associated with cardiovascular interventions, was described predominantly following catheter ablation procedures [18][19][20][21][22][23][24]. The clinical significance of SCIs, by definition as-ymptomatic, is being discussed, and there are data linking this phenomenon with dementia and gradual cognitive decline [29,30].…”

Section: Incidence Of Silent Cerebral Infarcts Following the Ablationmentioning

confidence: 99%

“…To facilitate the AF ablation procedure, several "single-shot" devices have been developed [5][6][7][8], leading to substantial shortening of the procedure time with a safety profile and long-term success rate comparable to classical point-by-point PVI [9][10][11][12][13][14]. Silent cerebral infarcts (SCIs), detected by diffusion-weighted magnetic resonance imaging (DW-MRI), associated with many types of cardiovascular interventions, have been widely described [15][16][17][18], but they are usually linked with PVI procedures [19][20][21][22][23][24] due to the specific target areas in the left atrium and higher initial risk of thromboembolic events in the AF population. In some of the single-shot techniques, the reported increased incidence of SCIs, detected with post-procedural DW-MRI, is of particular concern [21,22].…”

Section: Introductionmentioning

confidence: 99%

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Silent cerebral infarcts following pulmonary vein isolation with different atrial fibrillation ablation techniques – incidence and risk factors

et al. 2019

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Introduction: Silent cerebral infarcts (SCIs) detected by diffusion-weighted magnetic resonance (DW-MRI) following atrial fibrillation (AF) ablation have been reported, with the incidence of 1-38%. We aimed to compare the incidence of SCIs following AF ablation with four different technologies and analyze the risk factors. Material and methods: A total of 104 patients (mean age: 59.9 ±9.5 years, 68 males) with symptomatic AF, referred for ablation, were included in the study. The AF ablation was performed with irrigated radiofrequency pointby-point technique (RF group) in 24 patients, and with 3 different single-shot techniques: phased-RF (PVAC) in 46, second-generation cryoballoon (CB) in 24 and irrigated multipolar RF catheter (nMARQ) in 10 patients. In all patients DW-MRI was performed pre-and post-procedurally to evaluate the incidence of SCIs. Procedural parameters, complication rate and post-procedural SCI incidence were compared between the groups. Results: Procedure (167.1 vs. 110.5 vs. 106.0 vs. 141.5 min, p < 0.001), fluoroscopy (22.7 vs. 15.9 vs. 16.3 vs. 15.3 min, p = 0.048) and LA dwell (101.5 vs. 53.9 vs. 56.0 vs. 97.0 min, p < 0.001) times compared respectively between RF, PVAC, CB and nMARQ groups were significantly shorter with single-shot techniques. The number of new-onset SCIs was 4/24 (16.7%) in RF, 7/46 (15.2%) in PVAC, 1/24 (4.2%) in CB and 1/10 (10%) in the nMARQ group. Univariate analysis identified procedure duration (p = 0.02), lower LV ejection fraction (p = 0.03), persistent form of arrhythmia (p = 0.007) and intraprocedural cardioversion (p = 0.002) as risk factors of new-onset SCIs. Conclusions: Silent cerebral infarcts can be detected following AF ablation regardless of the technology used. Prolonged procedure time, lower ejection fraction, persistent form of arrhythmia and intraprocedural cardioversion increase the risk of SCIs.

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Section: Study Populationsupporting

confidence: 91%

Section: Incidence Of Silent Cerebral Infarcts Following the Ablationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Silent cerebral infarcts following pulmonary vein isolation with different atrial fibrillation ablation techniques – incidence and risk factors

et al. 2019

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“…Given these reassuring studies that were in part done at our own centre, DW-MRI was not part of our regular peri-procedural assessment of safety as it is a burden to patients, as well as a logistical challenge that does not seem costeffective as it has no consequence for the patient. The issue of ACE lesions and their clinical significance after any type of ablation however remains in part unresolved, as is the fact that some operators achieve low rates (PRECISION GOLD De Greef et al 2.1% multicentre trial with strict procedural guidance, core lab strict MRI assessment) while others do not (Keçe et al, 23%, single-centre experience) [3,20].…”

Section: Safety Outcomesmentioning

confidence: 99%

Acute success and safety of the second-generation PVAC GOLD phased RF ablation catheter for atrial fibrillation

Klaver¹,

Wintgens

Wijffels

et al. 2020

J Interv Card Electrophysiol

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Purpose The second-generation multi-electrode catheter, pulmonary vein ablation catheter (PVAC) GOLD, was designed to improve the delivery of phased radiofrequency energy and reduce procedure times using a 'single-shot' approach for pulmonary vein isolation (PVI), while retaining efficacy and safety. This large registry presents acute success rates and safety outcomes in a daily practice setting. Methods A total of 1017 patients undergoing first-time ablation for atrial fibrillation (AF) using PVAC GOLD were included, 644 patients with paroxysmal AF and 373 patients with non-paroxysmal AF, divided into 175 patients receiving PVI only and 198 patients receiving PVI with additional substrate modification. Results High and comparable percentages of successful PVI could be achieved in all groups (98%, 95% and 99%; p = 0.108). The median total procedure time for all groups was 90 min [70-100]. As expected, the total procedure, ablation and fluoroscopy time were significantly longer in the PVI + substrate modification group compared with the PVI-only cases (all p < 0.001), but not between the PVI-only groups (p = 0.306, p = 0.088, p = 0.233, respectively). A total of 44 complications were observed in 43 patients (4.2%). Major complications were seen in 19 patients (1.87%) and non-major procedure-related complications were seen in 25 patients (2.46%). Complications leaving permanent sequelae were rare and occurred in only four patients (0.39%). Complications did not differ between groups (p = 0.199, p = 0.438, p = 0.240 and p = 0.465 respectively). Conclusion PVAC GOLD performs successful PVI, while reducing procedure times and retaining safety for paroxysmal, persistent and long-standing persistent AF. Safety was unaffected by additional substrate modification.

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“…Stroke and thromboembolism are among the most harmful periprocedural complications following AF ablation procedures ( 2 ). Although symptomatic cerebral embolisms are rare (<1%) during PVI procedures ( 3 , 4 ), new silent cerebral embolisms (SCEs) detected by cerebral magnetic resonance imaging (MRI) scans have a reported incidence of >10%, with some publications reporting SCEs in up to 30% of patients ( 5 , 6 ). The long-term clinical significance of SCEs remains unclear, however they may correlate with neurologic deficits, including an increased risk of dementia.…”

Section: Introductionmentioning

confidence: 99%

Atrial Fibrillation Ablation Using Robotic Magnetic Navigation Reduces the Incidence of Silent Cerebral Embolism

Zheng

Wang

Tang

et al. 2021

Front. Cardiovasc. Med.

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Background: The incidence of silent cerebral embolisms (SCEs) has been documented after pulmonary vein isolation using different ablation technologies; however, it is unreported in patients undergoing with atrial fibrillation (AF) ablation using Robotic Magnetic Navigation (RMN). The purpose of this prospective study was to investigate the incidence, risk predictors and probable mechanisms of SCEs in patients with AF ablation and the potential impact of RMN on SCE rates.Methods and Results: We performed a prospective study of 166 patients with paroxysmal or persistent AF who underwent pulmonary vein isolation. Patients were divided into RMN group (n = 104) and manual control (MC) group (n = 62), and analyzed for their demographic, medical, echocardiographic, and risk predictors of SCEs. All patients underwent cerebral magnetic resonance imaging within 48 h before and after the ablation procedure to assess cerebral embolism. The incidence and potential risk factors of SCEs were compared between the two groups. There were 26 total cases of SCEs in this study, including 6 cases in the RMN group and 20 cases in the MC group. The incidences of SCEs in the RMN group and the MC group were 5.77 and 32.26%, respectively (X2 = 20.63 P < 0.05). Univariate logistic regression analysis demonstrated that ablation technology, CHA2DS2-VASc score, history of cerebrovascular accident/transient ischemic attack, and low ejection fraction were significantly associated with SCEs, and multivariate logistic regression analysis showed that MC ablation was the only independent risk factor of SCEs after an AF ablation procedure.Conclusions: Ablation technology, CHA2DS2-VASc score, history of cerebrovascular accident/transient ischemic attack, and low ejection fraction are associated with SCEs. However, ablation technology is the only independent risk factor of SCEs and RMN can significantly reduce the incidence of SCEs resulting from AF ablation.Clinical Trial Registration: ChiCTR2100046505.

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Incidence and Clinical Significance of Cerebral Embolism During Atrial Fibrillation Ablation With Duty-Cycled Phased-Radiofrequency Versus Cooled-Radiofrequency

Cited by 18 publications

References 22 publications

Silent cerebral infarcts following pulmonary vein isolation with different atrial fibrillation ablation techniques – incidence and risk factors

Silent cerebral infarcts following pulmonary vein isolation with different atrial fibrillation ablation techniques – incidence and risk factors

Acute success and safety of the second-generation PVAC GOLD phased RF ablation catheter for atrial fibrillation

Atrial Fibrillation Ablation Using Robotic Magnetic Navigation Reduces the Incidence of Silent Cerebral Embolism

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