title: Does the number of simultaneously activated electrodes during phased RF multielectrode ablation of atrial fibrillation influence the incidence of silent cerebral microembolism?
abstract: BACKGROUND
  Asymptomatic cerebral embolus (ACE) detected by diffusion-weighted magnetic resonance imaging (DW-MRI) following atrial fibrillation (AF) ablation has been reported at varying rates with different ablation techniques.
  
  
  OBJECTIVE
  To evaluate the incidence of ACE after phased radiofrequency ablation for AF with procedural modifications that potentially reduce the embolic load.
  
  
  METHODS
  One hundred twenty consecutive patients with AF underwent MRI before ablation, 24 hours after ablation, and at 4-6 weeks. In all patients, simultaneous activation of pulmonary vein ablation catheter electrode pairs 1 and 5 was forbidden. While in 60 group 1 patients, a maximum of 4 electrode pairs could be activated at a time, and in 60 group 2 patients, ablation was limited to a maximum of 2 pairs. All patients were on uninterrupted phenprocoumon, with an attempted activated clotting time of >300 seconds during ablation.
  
  
  RESULTS
  Both patient groups were comparable. A total of 28 DW-positive lesions were detected in 24 of 120 patients (20%). Seventeen group 1 patients (28.3%) were positive for new asymptomatic DW cerebral lesions compared with 7 group 2 patients (11.7%) (P = .039). During MRI follow-up, 3 patients (2.5%) were diagnosed with a small T2-positive asymptomatic glial scar. Procedure time was longer in group 2 patients than in group 1 patients (159 ± 39 vs 121 ± 15; P < .001).
  
  
  CONCLUSIONS
  Limiting the number of simultaneously activated electrode pairs to 2 significantly reduces the rate of ACE in patients treated with a multielectrode duty-cycled phased radiofrequency catheter system for AF. This reduction corresponds with a significant prolongation of the total procedure time.
authors.affiliation: Department of Electrophysiology, School of Medicine, Witten/Herdecke University, St. Agnes-Hospital Bocholt, Germany. drmwieczorek@t-online.de
authors.forename: Marcus
authors.initials: M
authors.lastname: Wieczorek
authors.forename: Reinhard
authors.initials: R
authors.lastname: Hoeltgen
authors.forename: Martin
authors.initials: M
authors.lastname: Brueck
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation*; D004566:Electrodes; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial; D055815:Young Adult