Cardiology

Impact of the type of electroanatomic mapping system on the incidence of cerebral embolism after radiofrequency catheter ablation of left atrial tachycardias.

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Impact of the type of electroanatomic mapping system on the incidence of cerebral embolism after radiofrequency catheter ablation of left atrial tachycardias.

Heart Rhythm. 2019 Sep 10;:

Authors: Nakamura K, Sasaki T, Take Y, Minami K, Inoue M, Kishi S, Yoshimura S, Sasaki W, Okazaki Y, Motoda H, Niijima K, Miki Y, Goto K, Yamashita E, Koyama K, Funabashi N, Naito S

Abstract
BACKGROUND: Left atrial tachycardias (ATs) often occur after left atrial ablation. The incidence of symptomatic and silent cerebral embolism after radiofrequency catheter ablation of left ATs and the impact of the type of 3-dimesional electroanatomic mapping (3D-EAM) system on the incidence of cerebral embolism remain unclear.
OBJECTIVE: This study aimed to investigate the incidence of cerebral embolism after a 3D-EAM system-guided left AT ablation, and compare that between the different 3D-EAM systems.
METHODS: We prospectively enrolled 59 patients who underwent a left AT ablation and brain magnetic resonance imaging after the procedure: 30 were guided by the Rhythmia™ system and 29 by the CARTO® system (Groups R and C).
RESULTS: One transient ischemic attack occurred in Group R and no symptomatic embolism occurred in Group C. Silent cerebral ischemic lesions (SCILs) were observed in 35 patients (59.3%), and Group R had a significantly higher incidence of SCILs than Group C (86.2% vs. 33.3%; P<0.001). In a multivariate analysis, Group R and a left atrial linear ablation were independent positive predictors of SCILs (odds ratios, 12.822 and 8.668; P=0.001 and 0.005). The incidence of bleeding complications was comparable between Groups R and C (0% vs. 3.3%, P=0.508).
CONCLUSIONS: Group R exhibited a higher incidence of post-ablation cerebral embolism than Group C. The use of the high resolution 3D-EAM system with a mini-basket catheter to guide radiofrequency ablation of left atrial macroreentrant tachycardias may markedly increase the risk of silent cerebral embolism. The present results require further validation in a randomized study.

PMID: 31518721 [PubMed – as supplied by publisher]

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