Arrhythmias & electrophysiologyCohort study
Incidence and predictors of stroke and silent cerebral embolism following very high-power short-duration atrial fibrillation ablation
- Prospective cohort study
- consecutive patients
Authors' conclusion
Very high-power, short-duration PVI is a safe technique with an excellent acute success rate. Silent cerebral embolism incidence in our cohort was below the previously reported range, with no clinically overt cerebral complications. Lower baseline generator impedance and loss of contact during ablation may contribute to a higher risk of SCEs.
Study context
- Population
- Consecutive patients undergoing pulmonary vein isolation (PVI) for AF using very high-power, short-duration (vHPSD)MRI subgroup n = 61
- Participants
- 328 patients
- Outcome
- Incidence of procedural complications, with emphasis on cerebral safety (stroke, TIA, silent cerebral embolism on diffusion-weighted brain MRI)
Main finding
As reported in the abstract
Cerebral safety
Stroke or TIA
0
Silent cerebral embolism on MRI within 24 h (MRI subgroup, n = 61)
5 of 61 (8.2%)
Observational data: associations, not effects.
Further findings
Procedural characteristics (overall cohort)
- Mean procedure time
- 69.6 ± 24.1 min
- Mean left atrial dwell time
- 46.5 ± 21.5 min
- First-pass isolation
- 82%
Predictors of silent cerebral embolism
- Baseline generator impedance, silent cerebral embolism (SCE) vs no SCE
- 105.8 vs. 112.6 Ω, P < 0.0001
- Intermittent loss of catheter-tissue contact during ablation, SCE vs no SCE
- 14.1% vs. 6.1%, P < 0.0001
- lower impedance and contact loss significantly associated with SCE
Original publication
Incidence and predictors of stroke and silent cerebral embolism following very high-power short-duration atrial fibrillation ablation. Europace. Published 1 November 2023. doi:10.1093/europace/euad327
Summarised from the published abstract; every number is checked against it