AIMS: Pulmonary vein (PV) isolation (PVI) utilizing a cryoballoon (CB) has become one of the standard therapeutic options for atrial fibrillation (AF). However, it connotes a potential risk of cerebral ischaemic events (CIEs). This study aimed to clarify the prevalence of CIEs after PVI using second-generation CBs assessed by magnetic resonance imaging (MRI) of the brain. METHODS AND RESULTS: This prospective observational study consisted of 160 patients that underwent PVI with second-generation CBs for drug-refractory AF. Irrigated radiofrequency (RF) ablation for 'touch-up' procedures was utilized when conduction gaps between the left atrium (LA) and PVs were found after the CB application. Radiofrequency linear ablation was added in select patients. Cerebral MRI and neurological examinations were performed on the day following the ablation procedure. The MRI depicted micro-cerebral infarctions in 43 patients (26.9%, 1.49 lesions per case). All patients were free from symptomatic focal neurological deficits. Touch up ablation was required for the PVI establishment in 35 patients (21.9%). Linear ablation was performed in 59 patients (36.9%). Additional RF ablation within the LA was an independent risk of CIEs in the uni- and multivariate analyses. When the analyses were limited to patients who had undergone only CB ablation, CIEs were found in 12 of 66 patients (18.2%). CONCLUSION: Pulmonary vein isolation utilizing second-generation CBs carries a negligible risk of symptomatic CIEs; however, it includes a comparable risk of asymptomatic CIEs as in the previous similar reports using the first-generation CB. Radiofrequency applications in addition to the CB within the LA were the only predictor of this adverse effect. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Pulmonary vein (PV) isolation (PVI) utilizing a cryoballoon (CB) has become one of the standard therapeutic options for atrial fibrillation (AF). However, it connotes a potential risk of cerebral ischaemic events (CIEs). This study aimed to clarify the prevalence of CIEs after PVI using second-generation CBs assessed by magnetic resonance imaging (MRI) of the brain. METHODS AND RESULTS: This prospective observational study consisted of 160 patients that underwent PVI with second-generation CBs for drug-refractory AF. Irrigated radiofrequency (RF) ablation for 'touch-up' procedures was utilized when conduction gaps between the left atrium (LA) and PVs were found after the CB application. Radiofrequency linear ablation was added in select patients. Cerebral MRI and neurological examinations were performed on the day following the ablation procedure. The MRI depicted micro-cerebral infarctions in 43 patients (26.9%, 1.49 lesions per case). All patients were free from symptomatic focal neurological deficits. Touch up ablation was required for the PVI establishment in 35 patients (21.9%). Linear ablation was performed in 59 patients (36.9%). Additional RF ablation within the LA was an independent risk of CIEs in the uni- and multivariate analyses. When the analyses were limited to patients who had undergone only CB ablation, CIEs were found in 12 of 66 patients (18.2%). CONCLUSION: Pulmonary vein isolation utilizing second-generation CBs carries a negligible risk of symptomatic CIEs; however, it includes a comparable risk of asymptomatic CIEs as in the previous similar reports using the first-generation CB. Radiofrequency applications in addition to the CB within the LA were the only predictor of this adverse effect. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Paulus Kirchhof; Karl Georg Haeusler; Benjamin Blank; Joseph De Bono; David Callans; Arif Elvan; Thomas Fetsch; Isabelle C Van Gelder; Philip Gentlesk; Massimo Grimaldi; Jim Hansen; Gerhard Hindricks; Hussein R Al-Khalidi; Tyler Massaro; Lluis Mont; Jens Cosedis Nielsen; Georg Nölker; Jonathan P Piccini; Tom De Potter; Daniel Scherr; Ulrich Schotten; Sakis Themistoclakis; Derick Todd; Johan Vijgen; Luigi Di Biase Journal: Eur Heart J Date: 2018-08-21 Impact factor: 29.983
Authors: Indranill Basu-Ray; Dibbendhu Khanra; Péter Kupó; Jared Bunch; Sue A Theus; Anindya Mukherjee; Sumit K Shah; András Komócsi; Adedayo Adeboye; John Jefferies Journal: J Arrhythm Date: 2021-01-29
Authors: Mariëlle Kloosterman; Winnie Chua; Larissa Fabritz; Hussein R Al-Khalidi; Ulrich Schotten; Jens C Nielsen; Jonathan P Piccini; Luigi Di Biase; Karl Georg Häusler; Derick Todd; Lluis Mont; Isabelle C Van Gelder; Paulus Kirchhof Journal: Europace Date: 2020-07-01 Impact factor: 5.214