Silent cerebral events/lesions after second-generation cryoballoon ablation: How can we reduce the risk of silent strokes?

Heart Rhythm : the Official Journal of the Heart Rhythm Society
Shinsuke MiyazakiYoshito Iesaka

Abstract

Atrial fibrillation (AF) ablation is associated with a substantial risk of silent cerebral events/lesions (SCEs/SCLs) detected on magnetic resonance imaging (MRI). The purpose of this study was to investigate the factors associated with the incidence of SCEs/SCLs during second-generation cryoballoon ablation. Two hundred fifty-six AF patients underwent brain MRI 1 day after pulmonary vein (PV) isolation using second-generation cryoballoons with a single 28-mm balloon and short freeze strategy. Overall, 991 of 1016 PVs (97.5%) were successfully isolated by 4.9 ± 1.3 cryoballoon applications per patient, and 25 PVs required touch-up radiofrequency ablation. The total procedure time was 72.7 ± 26.1 minutes. SCEs and SCLs were detected in 68 (26.5%) and 27 (10.5%) patients, respectively. None of the patients reported any neurologic symptoms. Reinsertion of once withdrawn cryoballoons and subsequent applications significantly increased the incidence of SCEs (odds ratio [OR] 2.057; 95% confidential interval [CI] 1.051-4.028; P = .035), and additional left atrial mapping with a multielectrode catheter significantly increased the incidence of SCLs (OR 3.317; 95% CI 1.365-8.056; P = .008). Transient coronary air embolisms were significa...Continue Reading

Citations

Jul 28, 2019·Journal of Cardiovascular Electrophysiology·René van EsKars Neven
Mar 29, 2019·Arrhythmia & Electrophysiology Review·Shinsuke Miyazaki, Hiroshi Tada
Aug 3, 2019·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·Alan SugrueSamuel J Asirvatham
Nov 21, 2020·Pacing and Clinical Electrophysiology : PACE·Kohki NakamuraShigeto Naito
Jan 16, 2021·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Richard SchillingVivek Y Reddy
Nov 21, 2020·JACC. Clinical Electrophysiology·Tilman MaurerKarl-Heinz Kuck
Oct 29, 2020·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Marijn H A GroenKars Neven

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