Catheter Ablation of Atrial Fibrillation and Risk of Asymptomatic Cerebral Embolism

Recent studies have suggested that a significant minority of patients undergoing atrial fibrillation catheter ablation (AFCA) develop evidence of acute, asymptomatic cerebral emboli (ACE) detected by brain magnetic resonance imaging. Although the prognostic significance of ACE associated with AFCA remains unclear, given the heightened risk of dementia associated with asymptomatic chronic infarcts on brain imaging, it is imperative to understand the pathogenesis of ACE and identify methods to mitigate the risk of emboli associated with AF ablation. In this paper, we review the incidence of ACE associated with AFCA and discuss patient- and procedure-specific markers of risk for asymptomatic embolism. We also review the data to support strategies, which have been proposed to reduce the incidence of ACE.