title: Incidence and long-term follow-up of silent cerebral lesions after pulmonary vein isolation using a remote robotic navigation system as compared with manual ablation.
abstract: BACKGROUND
  The incidence of silent cerebral lesions (SCL) after atrial fibrillation (AF) ablation is highly variable, depending on the technology used. Recently, an increased risk for SCL has been described for a novel, nonirrigated ablation tool using multielectrode phased radiofrequency (PVAC). The aim of this prospective study was to evaluate the incidence and long-term follow-up of SCL in patients undergoing robotically assisted pulmonary vein isolation (RA-PVI) as compared with manual PVI.
  
  
  RESULTS
  Circumferential PVI using irrigated radiofrequency current was performed on 70 patients (41 patients with paroxysmal AF, 59%). Fifty patients underwent RA-PVI and 20 patients underwent a manual approach. Cerebral MRI was performed the day before and the day after the ablation procedure; follow-up MRI was performed on 9 of 12 (75%) patients after a follow-up period of 21 months. SCLs were found in 12 of 70 (17%) patients in this study; the incidence of SCLs was similar in patients undergoing RA-PVI as compared with manually ablated patients (n=9, 18% versus n=3, 15%; probability value=1.0). In 1 patient undergoing manual PVI (1%), an SCL with asymptomatic subarachnoid hemorrhage was detected; the bleeding completely resolved within 1 month. Transient ischemic attack occurred in 1 (1%) patient 2 days after manual PVI. After a median follow-up period of 21 months, no residual SCLs were detected.
  
  
  CONCLUSIONS
  The incidence of SCL using the robotic navigation system was 18% in this study. Incidence and size of SCL appears to be similar after RA-PVI as compared with manual PVI. Repeat MRI showed no residual SCLs at long-term follow-up.
authors.affiliation: Department of Cardiology and the Department of Radiology, Schwarzwald-Baar-Klinikum Villingen-Schwenningen GmbH, Academic Hospital of the University of Freiburg, Villingen-Schwenningen, Germany. arillig5@yahoo.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Rillig
authors.forename: Udo
authors.initials: U
authors.lastname: Meyerfeldt
authors.forename: Roland Richard
authors.initials: RR
authors.lastname: Tilz
authors.forename: Jochen
authors.initials: J
authors.lastname: Talazko
authors.forename: Anita
authors.initials: A
authors.lastname: Arya
authors.forename: Vlada
authors.initials: V
authors.lastname: Zvereva
authors.forename: Ralf
authors.initials: R
authors.lastname: Birkemeyer
authors.forename: Tomislav
authors.initials: T
authors.lastname: Miljak
authors.forename: Bajram
authors.initials: B
authors.lastname: Hajredini
authors.forename: Peter
authors.initials: P
authors.lastname: Wohlmuth
authors.forename: Ulrich
authors.initials: U
authors.lastname: Fink
authors.forename: Werner
authors.initials: W
authors.lastname: Jung
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D012307:Risk Factors; D012371:Robotics / Q000295:instrumentation*; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome