Cardiology Division, Department of Internal Medicine, San Giovanni Battista Hospital, University of Turin, Italy.
J Cardiovasc Electrophysiol. 2011 Sep;22(9):961-8. doi: 10.1111/j.1540-8167.2011.02050.x. Epub 2011 Mar 31.
Silent cerebral ischemic lesions have recently emerged as the most frequent complications after pulmonary vein isolation (PVI). To reduce thromboembolic complications, new types of catheters and energy source have been introduced in clinical practice. The study purpose is to compare the incidence of new silent cerebral ischemic events in patients with paroxysmal atrial fibrillation (PAF) undergoing PVI with different ablation technologies.
One hundred and eight patients (67% men; age 56 ± 9 years) with PAF were enrolled in a consecutive manner to undergo PVI performed with irrigated radiofrequency (RF) catheter (Group 1, 36 patients), multielectrode catheter (PVAC) associated with duty-cycled RF generator (Group 2, 36 patients) and cryoballoon (Group 3, 36 patients). The protocol included a cerebral magnetic resonance imaging before and after the procedure. After PVI, the following patients showed new silent cerebral ischemic lesions at postprocedural cerebral MRI: 3 patients in Group 1 (8.3%), 14 patients in Group 2 (38.9%), 2 patients in Group 3 (5.6%). PVAC related to higher incidence of silent cerebral ischemic events compared to irrigated RF (P = 0.002) and cryoballoon (P = 0.001), whereas no statistical differences were found between irrigated RF catheter and cryoballoon groups (8.3% vs 5.6%, P = 0.5). At the multivariate analysis, the only independent predictor of new ischemic asymptomatic cerebral lesions after PVI was ablation performed with PVAC (OR 1.48 95% CI 1.19-1.62, P < 0.001).
The incidence of silent cerebral lesions after PVI is different depending on technologies used: PVAC increases the risk of 1.48 times compared to irrigated RF and cryoballoon ablation.
最近，沉默性脑缺血性病变已成为肺静脉隔离（PVI）后最常见的并发症。为了减少血栓栓塞并发症，新型导管和能源已在临床实践中引入。本研究旨在比较不同消融技术治疗阵发性心房颤动（PAF）患者 PVI 后新发沉默性脑缺血事件的发生率。
连续纳入 108 例 PAF 患者（67%为男性；年龄 56±9 岁）行 PVI，分别使用灌流射频（RF）导管（1 组，36 例）、多极导管（PVAC）联合定频 RF 发生器（2 组，36 例）和冷冻球囊（3 组，36 例）。方案包括术前行及术后行脑 MRI。PVI 后，以下患者在术后脑 MRI 上出现新的沉默性脑缺血性病变：1 组 3 例（8.3%），2 组 14 例（38.9%），3 组 2 例（5.6%）。与灌流 RF 相比，PVAC 与更高的沉默性脑缺血事件发生率相关（P = 0.002）和冷冻球囊（P = 0.001），而灌流 RF 导管与冷冻球囊组之间无统计学差异（8.3%vs5.6%，P = 0.5）。多变量分析显示，PVI 后新发无症状性脑缺血性病变的唯一独立预测因子是使用 PVAC 进行消融（OR 1.48，95%CI 1.19-1.62，P <0.001）。
PVI 后沉默性脑病变的发生率因技术不同而异：与灌流 RF 和冷冻球囊消融相比，PVAC 使风险增加 1.48 倍。
