title: Incidence of asymptomatic intracranial embolic events after pulmonary vein isolation: comparison of different atrial fibrillation ablation technologies in a multicenter study.
abstract: OBJECTIVE
  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.
authors.affiliation: Arrhythmia Department, Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany. claudia.h.siklody@gmail.com.
authors.forename: Claudia
authors.initials: C
authors.lastname: Herrera Siklódy
authors.forename: Thomas
authors.initials: T
authors.lastname: Deneke
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.forename: Heiko
authors.initials: H
authors.lastname: Lehrmann
authors.forename: Dong-In
authors.initials: DI
authors.lastname: Shin
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Susanne
authors.initials: S
authors.lastname: Henschke
authors.forename: Peter
authors.initials: P
authors.lastname: Fluegel
authors.forename: Jochen
authors.initials: J
authors.lastname: Schiebeling-Römer
authors.forename: Paul M
authors.initials: PM
authors.lastname: Bansmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Bourdias
authors.forename: Vincent
authors.initials: V
authors.lastname: Dousset
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
authors.forename: Thomas
authors.initials: T
authors.lastname: Arentz
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D003452:Cryosurgery / Q000009:adverse effects; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011667:Pulmonary Veins / Q000601:surgery*; D007507:Therapeutic Irrigation
chemical_list: D000925:Anticoagulants