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Incidence and characteristics of silent cerebral embolisms after radiofrequency‐based atrial fibrillation ablation: A propensity score‐matched analysis between different mapping catheters and indices for guiding ablation
Author(s) -
Nakamura Kohki,
Sasaki Takehito,
Take Yutaka,
Minami Kentaro,
Inoue Mitsuho,
Asahina Chisa,
Sasaki Wataru,
Kishi Shohei,
Yoshimura Shingo,
Okazaki Yoshinori,
Motoda Hiroyuki,
Niijima Katsura,
Miki Yuko,
Goto Koji,
Kaseno Kenichi,
Yamashita Eiji,
Koyama Keiko,
Funabashi Nobusada,
Naito Shigeto
Publication year - 2021
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.14800
Subject(s) - medicine , ablation , atrial fibrillation , incidence (geometry) , catheter ablation , propensity score matching , radiofrequency ablation , magnetic resonance imaging , cardiology , surgery , nuclear medicine , radiology , physics , optics
The difference in the incidence and characteristics of silent cerebral events (SCEs) after radiofrequency‐based atrial fibrillation (AF) ablation between the different mapping catheters and indices used for guiding radiofrequency ablation remains unclear. This study aimed to compare the incidence and characteristics of postablation SCEs between the following two groups: Group C, Ablation Index‐guided ablation using two circular mapping catheters with CARTO (Biosense Webster); Group R, local impedance‐guided ablation using one mini‐basket catheter and one circular mapping with Rhythmia (Boston Scientific). Methods and Results Of 211 consecutive patients who underwent an AF ablation and brain magnetic resonance (MR) imaging after the ablation, 120 patients (each group, n = 60) were selected by propensity score matching. SCEs were detected in 37 patients (30.8%). Group R had a higher incidence of SCEs (51.7% vs. 10.0%; p < .001) and more SCEs per patient (median, 3 vs. 1, p = .028) than Group C. A multivariate analysis demonstrated that nonparoxysmal AF and being Group R were independent positive predictors of SCEs (odds ratios, 6.930 and 15.464; both p < .001). On the follow‐up MR imaging, all SCEs in Group C and 87.9% of the SCEs in Group R disappeared ( p = .537). Conclusions Group R had a significantly higher incidence of SCEs than Group C. Most probably the use of a complexly designed basket mapping catheter is the reason for the difference in the incidence of SCEs but further validation is needed. A nonparoxysmal form of AF may also increase the risk of SCEs during these ablation procedures.