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

2018; Elsevier BV; Volume: 16; Issue: 1 Linguagem: Inglês

10.1016/j.hrthm.2018.07.011

1556-3871

Shinsuke Miyazaki, Takatsugu Kajiyama, Kazuya Yamao, Masahiro Hada, Masao Yamaguchi, Hiroaki Nakamura, Hitoshi Hachiya, Hiroshi Tada, Kenzo Hirao, Yoshito Iesaka,

Venous Thromboembolism Diagnosis and Management

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 Reinsertion of once withdrawn cryoballoons and subsequent applications significantly increased the incidence of SCEs (odds ratio [OR] 2.057; 95% confidential interval [CI] 1.051-4.028; P =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 significantly associated with the incidence of SCLs (OR 3.447; 95% CI 1.015-11.702; P = 0.047). On the contrary, an uninterrupted anticoagulation regimen, use of radiofrequency deliveries for transseptal access, cryoballoon air removal with extracorporeal balloon inflations, strength of the MRI magnet, internal electrical cardioversion, and touch-up ablation were not associated with the incidence of SCEs/SCLs.A significant number of SCE/SCL occurrences was observed after second-generation cryoballoon ablation procedures. These results suggest that air embolisms are the main mechanism of SCEs/SCLs, and the injected air volume might determine the lesion type.