Author + information
- Thomas Deneke,
- Martin Bansmann,
- Joachim Krug,
- Andreas Mügge,
- Rainer Schmitt,
- Sebastian Kerber,
- Karin Nentwich,
- Pawel Majewski,
- Dong-In Shin and
- Anja Schade
Cerebral lesions (SCL) have been detected on post interventional magnetic resonance imaging (MRI) in asymptomatic patients after atrial fibrillation (AF) ablation procedures. The present study evaluates incidence and potential contributing factors for SCL in a large cohort of patients undergoing radiofrequency (RF), endoscopic laser balloon (EAS) or cryo-balloon (CB) ablation of AF.
All patients eligible for pre- and post-ablation MRI were included. Patients underwent AF ablation using cooled-tip single-tip RF (group 1), multipolar phased RF (group 2), EAS (group 3) or CB (group 4) ablation. MRI was performed before, after and in cases of detected SCL 2 to 6 weeks after ablation. SCL were defined as new onset lesion with hyperintense signal in diffusion weighted imaging and hypointense signal on apparent diffusion coefficient map.
A total of 237 patients were included and no patient had acute cerebral lesions identified on pre-ablation MRI. On post-ablation MRI 83 patients (35%) had a total of 232 SCLs (2.8/pt). 20% of group 1, 41% of group 2, 37% of group 3 and 21% of group 4 patients had documented SCLs. When dividing group 2 into patients only undergoing pulmonary vein isolation (PVI) using the PVAC 37% (48 out of 118) had SCL and 78% (11 out of 14) undergoing PVI plus additional phased RF ablations had SCLs. Within group 1: 2.3 SCL/pt, group 2: 2.6/pt in PVI alone and 4.7/pt in PVI plus, in group 3: 2.3lesions/pt and in group 4 2.3/pt were identified. During follow-up of 2 to 6 weeks only 5 lesions (2% of SCLs) (all > 10mm diameter) were still identified on MRI and all other lesions were not detected any more. No pre-ablation parameter was identified to be a significant predictor of SCL occurrence.
SCL may be identified in a substantial portion of patients undergoing AF ablation. Incidence of SCL may vary according to the technology used. The incidence and number of lesions appears to be highest using phased RF PVI plus additional left atrial phased RF ablations. 98% of lesions appear to resolve in follow-up MRI and only large lesions (> 10mm) may cause cerebral scarring. Variable MRI-definitions and -technology may cause differences in incidences of SCLs.
Oral Contributions West, Room 2006
Sunday, March 10, 2013, 11:00 a.m.-11:15 a.m.
Session Title: The Invasive Approach to the Management of Atrial Fibrillation
Abstract Category: 4. Arrhythmias: AF/SVT
Presentation Number: 923-4
- 2013 American College of Cardiology Foundation