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A Prospective Randomized Single-Center Study on the Risk of Asymptomatic Cerebral Lesions Comparing Irrigated Radiofrequency Current Ablation with the Cryoballoon and the Laser Balloon

Authors


  • S.B. was supported by a grant from the European Heart Rhythm Association.

  • B.S. and K.R.J.C. received research grants and speaker honoraria from CardioFocus and are both consultants to Medtronic. A.F. is a consultant to Medtronic. Other authors: No disclosures.

  • CLINICAL TRIAL REGISTRATION: (https://drks-neu.uniklinik-freiburg.de/drks_web/; study number 00000782).

Address for correspondence: Boris Schmidt, M.D., Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein Str. 4, 60431 Frankfurt/M., Germany. Fax: +49-69-945028119; E-mail: b.schmidt@ccb.de

Asymptomatic Cerebral Lesions in AF Ablation

Background

Asymptomatic cerebral lesions (ACL) may occur during atrial fibrillation (AF) ablation. We sought to compare the ACL incidence between 3 contemporary technologies: (1) irrigated radiofrequency current (RFC), (2) the single big cryoballoon (CB), and (3) the endoscopic laser-balloon (LB) in a prospective randomized pilot study.

Methods and Results

Ninety-nine patients were treated in 3 groups. Diffusion weighted MRI was acquired pre- (n = 20) and 24–48 h postablation (n = 99).

After ablation, new ACL were detected in 22% of patients without significant differences between groups (RFC 8/33; CB 6/33; LB 8/33; P = 0.8). The presence of hypertension was identified as the only independent predictor of ACL by univariate regression analysis.

During LB ablation, more ablation lesions (140 ± 19 vs 119 ± 18; P = 0.007) were applied during longer procedures (166 ± 36 vs 143 ± 32 min; P = 0.05) in patients with ACL. Univariate analysis revealed that a higher number of ablation lesions predicted ACL (P = 0.02).

Conclusion

In this prospective, randomized, single-center pilot study, ablation technology did not influence the occurrence of ACL during AF ablation.

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