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Effect of ablation devices on intracranial embolic events examined
Siklódy C. J Am Coll Cardiol. 2011;doi:10.1016/j.jacc.2011.04.010.
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The use of a multi-electrode-phased radiofrequency pulmonary vein ablation catheter in a recent study resulted in a much higher incidence of subclinical intracranial embolic events compared with cryoballoon and conventional radiofrequency catheters.
“Recent studies have raised safety concerns about subclinical embolic events during pulmonary vein isolations,” the researchers wrote. “(In the recent study), the incidence and number of new lesions were significantly higher in patients treated with a multi-electrode phased radiofrequency pulmonary vein ablation catheter, with a predilection for the vertebrobasilar territory, favoring a cardiac origin.”
The multicenter, prospective, observational study comprised 74 patients with symptomatic atrial fibrillation who were in need of pulmonary vein isolation. The three ablation catheters tested in the study were conventional irrigated radiofrequency (n=27), cryoballoon (n=23) and multi-electrode-phased radiofrequency pulmonary vein ablation catheter (PVAC; n=24). Researchers performed cerebral MRI before and after the procedure.
Overall, procedure time was substantially shorter for PVAC compared with radiofrequency and cryoballoon catheters (P<.001), with findings on the neurological examination normal among all patients before and after ablation. For PVAC patients, post-procedure MRI revealed that 37.5% of the group had a median of three acute lesions, whereas 7.4% of radiofrequency and 4.3% in the cryoballoon patients had only one single embolic lesion.
As a result, the researchers concluded, “Improvement in PVAC technology and further studies to clarify the origin of these embolic lesions are mandatory to reduce the rate of silent embolisms during ablation procedures in the left atrium.”
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