Abstract 10254: Silent Cerebral Lesions After Atrial Fibrillation Ablation Using Different Ablation Technologies
Silent cerebral lesions (SCL) have been identified on magnetic resonance imaging (MRI) in patients after atrial fibrillation (AF) ablation. SCL represent irreversible cerebral damage, comparative analysis using a consistent MRI definition is missing and factors influencing the risk of SCL are poorly understood.
Methods: 276 Patients undergoing AF ablation underwent post-ablation cerebral MRI. SCL were identified based on a sensitive definition using a 1.5Tesla MRI. AF ablation was performed either using irrigated single-tip radiofrequency (RF) ablation (group 1), phased RF pulmonary vein isolation (PVI) (group 2), PVI plus additional phased RF ablation of left atrial fractionated electrogram sites using multipolar catheters (group 3), endoscopically-guided laser balloon (group 4), cryo-balloon PVI (group 5) and irrigated RF multipolar catheters (nMARQ) (group 6). Differences in regard to SCL rates were analyzed.
Results: In group 1 20%, in group 2 37%, in group 3 87%, in group 4 37%, in group 5 21% and in group 6 31% of patients had documented SCL. The incidence of SCL was significantly higher group 3 patients compared to all other groups. There was a significantly higher incidence of SCL in patients with compared to without exchanges of catheters over a single transseptal sheath (34% vs. 18%, p=0.007).
Conclusions: Technology-associated and procedural characteristics associated with a higher risk of SCL have been identified. Specifically catheter exchange over a single transseptal sheath is associated with a higher risk for SCL. Modification of procedural steps of the AF ablation procedure may further reduce the risk of SCL.
- © 2013 by American Heart Association, Inc.