title: Incidence of silent cerebral thromboembolic lesions after atrial fibrillation ablation may change according to technology used: comparison of irrigated radiofrequency, multipolar nonirrigated catheter and cryoballoon.
abstract: BACKGROUND
  Silent cerebral ischemic lesions have recently emerged as the most frequent complications after pulmonary vein isolation (PVI). To reduce thromboembolic complications, new types of catheters and energy source have been introduced in clinical practice. The study purpose is to compare the incidence of new silent cerebral ischemic events in patients with paroxysmal atrial fibrillation (PAF) undergoing PVI with different ablation technologies.
  
  
  RESULTS
  One hundred and eight patients (67% men; age 56 ± 9 years) with PAF were enrolled in a consecutive manner to undergo PVI performed with irrigated radiofrequency (RF) catheter (Group 1, 36 patients), multielectrode catheter (PVAC) associated with duty-cycled RF generator (Group 2, 36 patients) and cryoballoon (Group 3, 36 patients). The protocol included a cerebral magnetic resonance imaging before and after the procedure. After PVI, the following patients showed new silent cerebral ischemic lesions at postprocedural cerebral MRI: 3 patients in Group 1 (8.3%), 14 patients in Group 2 (38.9%), 2 patients in Group 3 (5.6%). PVAC related to higher incidence of silent cerebral ischemic events compared to irrigated RF (P = 0.002) and cryoballoon (P = 0.001), whereas no statistical differences were found between irrigated RF catheter and cryoballoon groups (8.3% vs 5.6%, P = 0.5). At the multivariate analysis, the only independent predictor of new ischemic asymptomatic cerebral lesions after PVI was ablation performed with PVAC (OR 1.48 95% CI 1.19-1.62, P < 0.001).
  
  
  CONCLUSIONS
  The incidence of silent cerebral lesions after PVI is different depending on technologies used: PVAC increases the risk of 1.48 times compared to irrigated RF and cryoballoon ablation.
authors: Cardiology Division, Department of Internal Medicine, San Giovanni Battista Hospital, University of Turin, Italy. gaitaf@libero.it
authors: Fiorenzo
authors: F
authors: Gaita
authors: Jean François
authors: JF
authors: Leclercq
authors: Burghard
authors: B
authors: Schumacher
authors: Marco
authors: M
authors: Scaglione
authors: Elisabetta
authors: E
authors: Toso
authors: Franck
authors: F
authors: Halimi
authors: Anja
authors: A
authors: Schade
authors: Steffen
authors: S
authors: Froehner
authors: Volker
authors: V
authors: Ziegler
authors: Domenico
authors: D
authors: Sergi
authors: Federico
authors: F
authors: Cesarani
authors: Alessandro
authors: A
authors: Blandino
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000209:etiology; D003452:Cryosurgery / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013923:Thromboembolism / Q000453:epidemiology* / Q000209:etiology