Silent cerebral infarcts following pulmonary vein isolation with different atrial fibrillation ablation techniques - incidence and risk factors

被引:10
|
作者
Glowniak, Andrzej [1 ]
Tarkowski, Adam [1 ]
Janczarek, Marzena [2 ]
Wysokinski, Andrzej [1 ]
机构
[1] Med Univ Lublin, Dept Cardiol, 8 Jaczewskiego St, PL-20954 Lublin, Poland
[2] Med Univ Lublin, Dept Intervent Radiol & Neuroradiol, Lublin, Poland
关键词
atrial fibrillation; cryoballoon; phased-radiofrequency ablation; pulmonary vein isolation; silent cerebral infarcts; RADIOFREQUENCY CATHETER ABLATION; IRRIGATED RADIOFREQUENCY; MULTIELECTRODE ABLATION; SINGLE-CENTER; LESIONS; CRYOBALLOON; COMPLICATIONS; PREVALENCE; MANAGEMENT; EMBOLISM;
D O I
10.5114/aoms.2019.85348
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction: Silent cerebral infarcts (SCIs) detected by diffusion-weighted magnetic resonance (DW-MRI) following atrial fibrillation (AF) ablation have been reported, with the incidence of 1-38%. We aimed to compare the incidence of SCIs following AF ablation with four different technologies and analyze the risk factors. Material and methods: A total of 104 patients (mean age: 59.9 +/- 9.5 years, 68 males) with symptomatic AF, referred for ablation, were included in the study. The AF ablation was performed with irrigated radiofrequency point by-point technique (RF group) in 24 patients, and with 3 different single-shot techniques: phased-RF (PVAC) in 46, second-generation cryoballoon (CB) in 24 and irrigated multipolar RF catheter (nMARQ) in 10 patients. In all patients DW-MRI was performed pre-and post-procedurally to evaluate the incidence of SCIs. Procedural parameters, complication rate and post -procedural SCI incidence were compared between the groups. Results: Procedure (167.1 vs. 110.5 vs. 106.0 vs. 141.5 min, p < 0.001), fluoroscopy (22.7 vs. 15.9 vs. 16.3 vs. 15.3 min, p = 0.048) and LA dwell (101.5 vs. 53.9 vs. 56.0 vs. 97.0 min, p < 0.001) times compared respectively between RF, PVAC, CB and nMARQ groups were significantly shorter with single-shot techniques. The number of new-onset SCIs was 4/24 (16.7%) in RF, 7/46 (15.2%) in PVAC, 1/24 (4.2%) in CB and 1/10 (10%) in the nMARQ group. Univariate analysis identified procedure duration (p = 0.02), lower LV ejection fraction (p = 0.03), persistent form of arrhythmia (p = 0.007) and intraprocedural cardioversion (p = 0.002) as risk factors of new-onset SCIs. Conclusions: Silent cerebral infarcts can be detected following AF ablation regardless of the technology used. Prolonged procedure time, lower ejection fraction, persistent form of arrhythmia and intraprocedural cardioversion increase the risk of SCIs.
引用
收藏
页码:632 / 638
页数:7
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