title: Incidence of silent cerebral infarctions after catheter ablation of atrial fibrillation utilizing the second-generation cryoballoon.
abstract: OBJECTIVE
  Pulmonary vein (PV) isolation (PVI) utilizing a cryoballoon (CB) has become one of the standard therapeutic options for atrial fibrillation (AF). However, it connotes a potential risk of cerebral ischaemic events (CIEs). This study aimed to clarify the prevalence of CIEs after PVI using second-generation CBs assessed by magnetic resonance imaging (MRI) of the brain.
  
  
  RESULTS
  This prospective observational study consisted of 160 patients that underwent PVI with second-generation CBs for drug-refractory AF. Irrigated radiofrequency (RF) ablation for 'touch-up' procedures was utilized when conduction gaps between the left atrium (LA) and PVs were found after the CB application. Radiofrequency linear ablation was added in select patients. Cerebral MRI and neurological examinations were performed on the day following the ablation procedure. The MRI depicted micro-cerebral infarctions in 43 patients (26.9%, 1.49 lesions per case). All patients were free from symptomatic focal neurological deficits. Touch up ablation was required for the PVI establishment in 35 patients (21.9%). Linear ablation was performed in 59 patients (36.9%). Additional RF ablation within the LA was an independent risk of CIEs in the uni- and multivariate analyses. When the analyses were limited to patients who had undergone only CB ablation, CIEs were found in 12 of 66 patients (18.2%).
  
  
  CONCLUSIONS
  Pulmonary vein isolation utilizing second-generation CBs carries a negligible risk of symptomatic CIEs; however, it includes a comparable risk of asymptomatic CIEs as in the previous similar reports using the first-generation CB. Radiofrequency applications in addition to the CB within the LA were the only predictor of this adverse effect.
authors.affiliation: Heart Center, Yokohama City Bay Red Cross Hospital, 1-12-3 Shin-yamashita, Naka-ward, Yokohama, Japan.
authors.forename: Tomofumi
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Heart Center, Yokohama City Bay Red Cross Hospital, 1-12-3 Shin-yamashita, Naka-ward, Yokohama, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Okishige
authors.affiliation: Department of Neurology, Yokohama City Bay Red Cross Hospital, 1-12-3 Shin-yamashita, Naka-ward, Yokohama, Japan.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Kanazawa
authors.affiliation: Heart Center, Yokohama City Bay Red Cross Hospital, 1-12-3 Shin-yamashita, Naka-ward, Yokohama, Japan.
authors.forename: Mitsumi
authors.initials: M
authors.lastname: Yamashita
authors.affiliation: Heart Center, Yokohama City Bay Red Cross Hospital, 1-12-3 Shin-yamashita, Naka-ward, Yokohama, Japan.
authors.forename: Naohiko
authors.initials: N
authors.lastname: Kawaguchi
authors.affiliation: Heart Center, Yokohama City Bay Red Cross Hospital, 1-12-3 Shin-yamashita, Naka-ward, Yokohama, Japan.
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Kato
authors.affiliation: Heart Center, Yokohama City Bay Red Cross Hospital, 1-12-3 Shin-yamashita, Naka-ward, Yokohama, Japan.
authors.forename: Hideshi
authors.initials: H
authors.lastname: Aoyagi
authors.affiliation: Heart Center, Yokohama City Bay Red Cross Hospital, 1-12-3 Shin-yamashita, Naka-ward, Yokohama, Japan.
authors.forename: Yasuteru
authors.initials: Y
authors.lastname: Yamauchi
authors.affiliation: Heart Rhythm Center, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Sasano
authors.affiliation: Heart Rhythm Center, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, Japan.
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirao
mesh_terms: D000200:Action Potentials; D000368:Aged; D058070:Asymptomatic Diseases; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000009:adverse effects* / Q000295:instrumentation; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016009:Chi-Square Distribution; D003452:Cryosurgery / Q000009:adverse effects* / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006339:Heart Rate; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Atrial fibrillation; Cerebral infarction; Cryoballoon; Pulmonary vein isolation