Abstract 18975: Phased RF Evaluation of Acute Pulmonary Vein Isolation in Paroxysmal AF With New GENius and PVAC GOLD: the PRECISION-GOLD Study
Introduction: The incidence of new asymptomatic cerebral embolism (ACE) after catheter ablation for atrial fibrillation (AF) ranges from 2 to 40%. The ERACE study demonstrated that procedural maneuvers to reduce emboli can achieve a low ACE incidence (1.7%) with a platinum multi-electrode radiofrequency (RF) ablation catheter (PVAC). A new multi-electrode catheter, PVAC GOLD, was designed to simplify emboli reduction and improve RF delivery.
Hypothesis: The purpose of the PRECISION-GOLD study is to evaluate ACE incidence after pulmonary vein isolation (PVI) using PVAC GOLD.
Methods: Patients (pts) with paroxysmal AF aged between 18 and 70 were included if without recent invasive cardiac procedure or stroke/TIA. Uninterrupted anticoagulation, submerged catheter introduction, and procedural heparinization to achieve ACT >350 seconds were applied to minimize emboli. DW-MRI was performed within 3 days before and after ablation, and again after 30 days in the presence of new DW lesions. Cognitive function as assessed by the Mini-Mental State Exam was evaluated at baseline and 30 days.
Results: From 10 centers, a total of 56 pts were enrolled, 51 pts treated, with 48 pts evaluated for ACE (underwent ablation with only PVAC GOLD and had pre/post ablation MRI). The majority of pts (71%) had chronic pre-ablation abnormalities on FLAIR, including 1 pt with recent asymptomatic infarct on DW. The most common energy mode used was 2:1 (57%). 10 pts (20%) received electrical cardioversion during the procedure. Post-procedure DW-MRI revealed only 1 pt (2%) with 1 new ACE lesion, which was not detected on DW-MRI at 1 month. No decline in cognitive function was observed.
Conclusions: Paroxysmal AF pts have a high burden of pre-existing chronic asymptomatic cerebral lesions on DW-MRI. AF ablation with the new PVAC GOLD results in a low incidence of ACE after AF ablation.
Author Disclosures: Y. De Greef: None. L. Boersma: None. L. Dekker: None. S. Murray: None. M. Wieczorek: None. N. Davidson: None. S. Spitzer: None. M. Hocini: None. S. Furniss: None. C. Geller: None. Z. Csanadi: None.
- © 2014 by American Heart Association, Inc.