title: A prospective randomized single-center study on the risk of asymptomatic cerebral lesions comparing irrigated radiofrequency current ablation with the cryoballoon and the laser balloon.
abstract: BACKGROUND
  Asymptomatic cerebral lesions (ACL) may occur during atrial fibrillation (AF) ablation. We sought to compare the ACL incidence between 3 contemporary technologies: (1) irrigated radiofrequency current (RFC), (2) the single big cryoballoon (CB), and (3) the endoscopic laser-balloon (LB) in a prospective randomized pilot study.
  
  
  RESULTS
  Ninety-nine patients were treated in 3 groups. Diffusion weighted MRI was acquired pre- (n = 20) and 24-48 h postablation (n = 99). After ablation, new ACL were detected in 22% of patients without significant differences between groups (RFC 8/33; CB 6/33; LB 8/33; P = 0.8). The presence of hypertension was identified as the only independent predictor of ACL by univariate regression analysis. During LB ablation, more ablation lesions (140 ± 19 vs 119 ± 18; P = 0.007) were applied during longer procedures (166 ± 36 vs 143 ± 32 min; P = 0.05) in patients with ACL. Univariate analysis revealed that a higher number of ablation lesions predicted ACL (P = 0.02).
  
  
  CONCLUSIONS
  In this prospective, randomized, single-center pilot study, ablation technology did not influence the occurrence of ACL during AF ablation.
authors.affiliation: Cardioangiologisches Centrum Bethanien, Frankfurt/M., Germany. b.schmidt@ccb.de
authors.forename: Boris
authors.initials: B
authors.lastname: Schmidt
authors.forename: Melanie
authors.initials: M
authors.lastname: Gunawardene
authors.forename: Detlef
authors.initials: D
authors.lastname: Krieg
authors.forename: Stefano
authors.initials: S
authors.lastname: Bordignon
authors.forename: Alexander
authors.initials: A
authors.lastname: Fürnkranz
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kulikoglu
authors.forename: Wilfried
authors.initials: W
authors.lastname: Herrmann
authors.forename: K R Julian
authors.initials: KR
authors.lastname: Chun
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001927:Brain Diseases / Q000175:diagnosis* / Q000209:etiology*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D016292:Procedural Sedation; D003452:Cryosurgery / Q000009:adverse effects* / Q000379:methods; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects* / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012307:Risk Factors; D007507:Therapeutic Irrigation; D016896:Treatment Outcome
keywords: atrial fibrillation; catheter ablation; cryoballoon; laser; microemboli; stroke