Abstract 14157: Predictors of Asymptomatic Cerebral Infarction associated with Radiofrequency Catheter Ablation for Atrial Fibrillation using an Irrigated-tip Catheter.
Objective: Catheter ablation (CA) is potentially curative treatment for atrial fibrillation (AF). However, complications are more frequent and more severe compared with other ablation procedures. The aim was to evaluate the predictors of cerebral infarction identified by diffusion-weighted magnetic resonance imaging (DWMRI) after AF ablation using an irrigated catheter.
Methods: A total of 241 consecutive AF patients underwent circumferential pulmonary vein isolation (CPVI) and, if necessary, liner and CFAE ablation using a 3.5mm-irrigated tip radiofrequency catheter. One patient had double vision resulting from cerebral infarction. 41 of them (63±10 years, proximal/chronic: 24/17) undergoing DWMRI brain scans 1-day after the procedure were examined. They were divided into two groups; Group 1: with cerebral infarction detected (n=4), and Group 2: without it (n=37).
Results: All of the group 1 patients had asymptomatic cerebral infarction. There were no significant differences in the LA dimensions, ejection fraction, pre-procedural prothorombin international normalized ratio and BNP level, CHADS(2) score, age, gender, LAA outlet flow and structural heart diseases between the 2 groups. However, the spontaneous echo contrast (SEC) grade over 2 defined by transesophageal echocardiography was significantly detected in Group 1 (p<0.01). With regard to CA characteristics, only the time to heparin injection during the procedure reached significant difference between the two groups (p<0.01). Interestingly, procedure time, RF application time, number, energy, and the presence of liner or CFAE ablation did not differ between the two groups. In a logistic regression analysis, the SEC (OR 49.07, p=0.03) and the time to heparin injection during procedure (OR 1.29, p=0.03) were independent predictors of asymptomatic cerebral infarction.
Conclusions: These results suggest that the SEC grade over 2 and the time to heparin injection during CA procedure could predict asymptomatic cerebral infarction associated with AF ablation using an irrigated-tip catheter.
- Atrial fibrillation
- Ablation, radiofrequency
- Cerebrovascular disorders
- Magnetic resonance imaging
- Risk factors
- © 2010 by American Heart Association, Inc.