Second-generation cryoballoon ablation for paroxysmal atrial fibrillation was associated with silent cerebral events in 32.3% and silent cerebral lesions in 11.7% of patients.
Observational (n=40)
What procedural steps during second-generation cryoballoon ablation for paroxysmal atrial fibrillation generate microembolic signals and silent cerebral events?
Second-generation cryoballoon ablation generates significant microembolic signals and silent cerebral events, particularly during phases with a high probability of gaseous emboli.
BACKGROUND: Atrial fibrillation ablation is associated with substantial risks of silent cerebral events (SCEs) or silent cerebral lesions. We investigated which procedural processes during cryoballoon procedures carried a risk. METHODS AND RESULTS: Forty paroxysmal atrial fibrillation patients underwent pulmonary vein isolation using second-generation cryoballoons with single 28-mm balloon 3-minute freeze techniques. Microembolic signals (MESs) were monitored by transcranial Doppler throughout all procedures. Brain magnetic resonance imaging was obtained pre- and post-procedure in 34 patients (85.0%). Of 158 pulmonary veins, 152 (96.2%) were isolated using cryoablation, and 6 required touch-up radiofrequency ablation. A mean of 5.0±1.2 cryoballoon applications was applied, and the left atrial dwell time was 76.7±22.4 minutes. The total MES counts/procedures were 522 (426-626). Left atrial access and Flexcath sheath insertion generated 25 (11-44) and 34 (24-53) MESs. Using radiofrequency ablation for transseptal access increased the MES count during transseptal punctures. During cryoapplications, MES counts were greatest during first applications (117 81-157), especially after balloon stretch/deflations (43 21-81). Pre- and post-pulmonary vein potential mapping with Lasso catheters generated 57 (21-88) and 61 (36-88) MESs. Reinsertion of once withdrawn cryoballoons and subsequent applications produced 205 (156-310) MESs. Touch-up ablation generated 32 (19-62) MESs, whereas electric cardioversion generated no MESs. SCEs and silent cerebral lesions were detected in 11 (32.3%) and 4 (11.7%) patients, respectively. The patients with SCEs were older than those without; however, there were no significant factors associated with SCEs. CONCLUSIONS: A significant number of MESs and SCE/silent cerebral lesion occurrences were observed during second-generation cryoballoon ablation procedures. MESs were recorded during a variety of steps throughout the procedure; however, the majority occurred during phases with a high probability of gaseous emboli.
Miyazaki et al. (Fri,) conducted a observational in Paroxysmal atrial fibrillation (n=40). Second-generation cryoballoon ablation was evaluated on Silent cerebral events (SCEs). Second-generation cryoballoon ablation for paroxysmal atrial fibrillation was associated with silent cerebral events in 32.3% and silent cerebral lesions in 11.7% of patients.