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

Published:September 10, 2019DOI:


      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-dimensional electroanatomic mapping (3D-EAM) system on the incidence of cerebral embolism remain unclear.


      This study aimed to investigate the incidence of cerebral embolism after a 3D-EAM system–guided left AT ablation procedure and compare that between the different 3D-EAM systems.


      We prospectively enrolled 59 patients who underwent left AT ablation and brain magnetic resonance imaging after the procedure: 30 were guided by the Rhythmia system (Boston Scientific, Marlborough, MA) and 29 by the CARTO system (Biosense Webster, Diamond Bar, CA) (groups R and C, respectively).


      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 did group C (86.2% vs 33.3%; P < .001). In multivariate analysis, group R and left atrial linear ablation were independent positive predictors of SCILs (odds ratio 12.822 and 8.668; P = .001 and P = .005). The incidence of bleeding complications was comparable between groups R and C (0% vs 3.3%; P = .508).


      Group R exhibited a higher incidence of postablation cerebral embolism than did 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.


      To read this article in full you will need to make a payment


      Subscribe to Heart Rhythm
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Cappato R.
        • Calkins H.
        • Chen S.A.
        • et al.
        Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation.
        Circ Arrhythm Electrophysiol. 2010; 3: 32-38
        • Di Biase L.
        • Lakkireddy D.
        • Trivedi C.
        • et al.
        Feasibility and safety of uninterrupted periprocedural apixaban administration in patients undergoing radiofrequency catheter ablation for atrial fibrillation: results from a multicenter study.
        Heart Rhythm. 2015; 12: 1162-1168
        • von Bary C.
        • Deneke T.
        • Arentz T.
        • et al.
        Silent cerebral events as a result of left atrial catheter ablation do not cause neuropsychological sequelae—a MRI-controlled multicenter study.
        J Interv Card Electrophysiol. 2015; 43: 217-226
        • Muller P.
        • Halbfass P.
        • Szollosi A.
        • et al.
        Impact of periprocedural anticoagulation strategy on the incidence of new-onset silent cerebral events after radiofrequency catheter ablation of atrial fibrillation.
        J Interv Card Electrophysiol. 2016; 46: 203-211
        • Di Biase L.
        • Gaita F.
        • Toso E.
        • et al.
        Does periprocedural anticoagulation management of atrial fibrillation affect the prevalence of silent thromboembolic lesion detected by diffusion cerebral magnetic resonance imaging in patients undergoing radiofrequency atrial fibrillation ablation with open irrigated catheters? Results from a prospective multicenter study.
        Heart Rhythm. 2014; 11: 791-798
        • Wissner E.
        • Metzner A.
        • Neuzil P.
        • et al.
        Asymptomatic brain lesions following laserballoon-based pulmonary vein isolation.
        Europace. 2014; 16: 214-219
        • Gaita F.
        • Leclercq J.F.
        • Schumacher B.
        • et al.
        Incidence of silent cerebral thromboembolic lesions after atrial fibrillation ablation may change according to technology used: comparison of irrigated radiofrequency, multipolar nonirrigated catheter and cryoballoon.
        J Cardiovasc Electrophysiol. 2011; 22: 961-968
        • Scaglione M.
        • Blandino A.
        • Raimondo C.
        • et al.
        Impact of ablation catheter irrigation design on silent cerebral embolism after radiofrequency catheter ablation of atrial fibrillation: results from a pilot study.
        J Cardiovasc Electrophysiol. 2012; 23: 801-805
        • Gaita F.
        • Caponi D.
        • Pianelli M.
        • et al.
        Radiofrequency catheter ablation of atrial fibrillation: a cause of silent thromboembolism? Magnetic resonance imaging assessment of cerebral thromboembolism in patients undergoing ablation of atrial fibrillation.
        Circulation. 2010; 122: 1667-1673
        • Martinek M.
        • Sigmund E.
        • Lemes C.
        • et al.
        Asymptomatic cerebral lesions during pulmonary vein isolation under uninterrupted oral anticoagulation.
        Europace. 2013; 15: 325-331
        • Neumann T.
        • Kuniss M.
        • Conradi G.
        • et al.
        MEDAFI-Trial (Micro-Embolization During Ablation of Atrial Fibrillation): comparison of pulmonary vein isolation using cryoballoon technique vs. radiofrequency energy.
        Europace. 2011; 13: 37-44
        • Deneke T.
        • Nentwich K.
        • Schmitt R.
        • et al.
        Exchanging catheters over a single transseptal sheath during left atrial ablation is associated with a higher risk for silent cerebral events.
        Indian Pacing Electrophysiol J. 2014; 14: 240-249
        • Schmidt B.
        • Gunawardene M.
        • Krieg D.
        • et al.
        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.
        J Cardiovasc Electrophysiol. 2013; 24: 869-874
        • Rillig A.
        • Meyerfeldt U.
        • Tilz R.R.
        • et al.
        Incidence and long-term follow-up of silent cerebral lesions after pulmonary vein isolation using a remote robotic navigation system as compared with manual ablation.
        Circ Arrhythm Electrophysiol. 2012; 5: 15-21
        • Deneke T.
        • Shin D.I.
        • Balta O.
        • et al.
        Postablation asymptomatic cerebral lesions: long-term follow-up using magnetic resonance imaging.
        Heart Rhythm. 2011; 8: 1705-1711
        • Herrera Siklody C.
        • Deneke T.
        • Hocini M.
        • et al.
        Incidence of asymptomatic intracranial embolic events after pulmonary vein isolation: comparison of different atrial fibrillation ablation technologies in a multicenter study.
        J Am Coll Cardiol. 2011; 58: 681-688
        • Schrickel J.W.
        • Lickfett L.
        • Lewalter T.
        • et al.
        Incidence and predictors of silent cerebral embolism during pulmonary vein catheter ablation for atrial fibrillation.
        Europace. 2010; 12: 52-57
        • Tao S.
        • Otomo K.
        • Ono Y.
        • et al.
        Efficacy and safety of uninterrupted rivaroxaban taken preoperatively for radiofrequency catheter ablation of atrial fibrillation compared to uninterrupted warfarin.
        J Interv Card Electrophysiol. 2017; 48: 167-175
        • Nakamura K.
        • Naito S.
        • Sasaki T.
        • et al.
        Silent cerebral ischemic lesions after catheter ablation of atrial fibrillation in patients on 5 types of periprocedural oral anticoagulation- predictors of diffusion-weighted imaging-positive lesions and follow-up magnetic resonance imaging.
        Circ J. 2016; 80: 870-877
        • Kuwahara T.
        • Abe M.
        • Yamaki M.
        • et al.
        Apixaban versus warfarin for the prevention of periprocedural cerebral thromboembolism in atrial fibrillation ablation: multicenter prospective randomized study.
        J Cardiovasc Electrophysiol. 2016; 27: 549-554
        • Ichiki H.
        • Oketani N.
        • Ishida S.
        • et al.
        The incidence of asymptomatic cerebral microthromboembolism after atrial fibrillation ablation: comparison of warfarin and dabigatran.
        Pacing Clin Electrophysiol. 2013; 36: 1328-1335
        • JCS Joint Working Group
        Guidelines for Pharmacotherapy of Atrial Fibrillation (JCS 2013).
        Circ J. 2014; 78: 1997-2021