Asymptomatic brain lesions following laserballoon-based pulmonary vein isolation.
OBJECTIVE
Laserballoon-based pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF) has proven safe and effective. Silent brain lesions after AF ablation detected on magnetic resonance imaging (MRI) have been described for several technologies, but its incidence following laserballoon PVI is unknown. The current study sought to assess the incidence of new asymptomatic brain lesions in patients undergoing laserballoon-based PVI.


RESULTS
Patients referred for PVI underwent pre- and post-procedural MRI of the brain. A total of 86 patients were enroled into the study (laserballoon group: 44 patients, 15 female, age 63 ± 9 years, left atrial (LA) diameter 43 ± 5 mm; cryoballoon group: 20 patients, 6 female, age 61 ± 9 years, LA diameter 41 ± 4 mm; and irrigated radiofrequency (RF) group: 22 patients, 11 female, age 64 ± 8 years, LA diameter 43 ± 6 mm). There was no statistically significant difference between the groups with regard to new asymptomatic brain lesions detected on post-procedural MRI: 5 of 44 (11.4%) patients in the laserballoon group, 1 of 20 (5.0%) patients in the cryoballoon group, and 4 of 22 (18.2%) patients in the irrigated RF group, respectively. In the laserballoon group, one additional patient with a new cerebral lesion experienced transient diplopia. In a multivariate regression model the only risk factor for asymptomatic new lesions was the CHA2DS2VASc score.


CONCLUSIONS
Following laserballoon-based PVI, new asymptomatic brain lesions were detected in 11.4% of patients. A higher CHA2DS2VASc score, but not the ablation technology utilized, was the only associated risk factor.
Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099 Hamburg, Germany.
Erik
E
Wissner
Andreas
A
Metzner
Petr
P
Neuzil
Jan
J
Petru
Jan
J
Skoda
Lucia
L
Sediva
Dietmar
D
Kivelitz
Peter
P
Wohlmuth
Jiri
J
Weichet
Bas
B
Schoonderwoerd
Peter
P
Rausch
Aleksander
A
Bardyszewski
Roland R
RR
Tilz
Feifan
F
Ouyang
Vivek Y
VY
Reddy
Karl-Heinz
KH
Kuck
D000368:Aged; D058070:Asymptomatic Diseases; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000209:etiology*; D016009:Chi-Square Distribution; D003452:Cryosurgery / Q000009:adverse effects*; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012307:Risk Factors; D007507:Therapeutic Irrigation; D013923:Thromboembolism / Q000175:diagnosis / Q000209:etiology*; D016896:Treatment Outcome
Atrial fibrillation; Brain lesion; Catheter ablation; Cryoballoon; Laserballoon; Magnetic resonance imaging