Silent Cerebral Infarcts Following Left-Sided Accessory Pathway Ablation in Wolff-Parkinson-White (WPW) Syndrome: A Preliminary Report

Abstract

Background Catheter ablation is a routine procedure in patients with WPW syndrome. Silent cerebral infarcts (SCI) detected in magnetic resonance imaging may be a complication of the ablation procedure, but it is well documented only in atrial fibrillation ablation. Ablation of left-sided accessory pathways (L-AP) has a similar target area, but WPW patients differ from those with atrial fibrillation, due to lower initial risk of cerebral embolic events. The aim of this study was to determine whether the ablation of left-sided accessory pathways carries the risk of SCI. Material/Methods Twenty consecutive patients with overt L-AP referred for RF ablation in our center were included in the study. An irrigated ablation catheter was used in 8 patients, and a non-irrigated ablation catheter was used in 12 patients. Diffusion-weighted magnetic resonance imaging was performed pre-procedurally and on the next day after the ablation in all patients. Results Ablation procedures were completed without complications and there were no neurological symptoms following the procedure, although in 2 patients (10%), post-procedural diffusion-weighted magnetic resonance revealed new acute silent cerebral infarcts. Both patients with new cerebral lesions were female, and a non-irrigated catheter was used in both cases. Conclusions This is the first study documenting the presence of silent cerebral infarcts after WPW ablation. Further investigations are needed to evaluate the risk of silent cerebral infarcts associated with L-AP ablation.

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

“…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].…”

“…Fortunately, clinically apparent stroke does not happen frequently enough during most cardiovascular procedures to help us to analyze its risk factors, except in very large cohorts. In our opinion, expressed before [18], SCIs can serve as a "substitute" of stroke, permitting the search for potential patient-and procedure-dependent risk factors in studies involving smaller numbers of patients. In our group, there was non-significantly lower incidence of SCIs in the group of patients ablated using second-generation cryoballoon, which is in line with the previously published data [21,22].…”

“…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].…”

Catheter ablation via the left atrium for atrioventricular nodal reentrant tachycardia: A narrative review

“…Silent cerebral infarcts, despite intraprocedural anticoagulation, have been described following catheter ablation of left-sided accessory pathways using nonirrigated radiofrequency catheters. 66 …”

“…Silent cerebral infarcts, despite intraprocedural anticoagulation, have been described following catheter ablation of left-sided accessory pathways using nonirrigated radiofrequency catheters. 66 In general, irrigated radiofrequency catheters are neither needed nor recommended for routine slow pathway ablation, so there is little published information on safe and effective settings. Nevertheless, open-irrigated radiofrequency catheters with contact force are associated with less thrombus and fewer steam pops.…”