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Cerebral safety after pulsed field ablation for paroxysmal atrial fibrillation

  • Author Footnotes
    1 Dr Nico Reinsch and Dr Anna Füting contributed equally to the study and the manuscript.
    Nico Reinsch
    Correspondence
    Address reprint requests and correspondence: Prof Dr Nico Reinsch, Department of Electrophysiology, Alfried Krupp Krankenhaus, Alfried-Krupp-Straße 21, 45131 Essen, Germany.
    Footnotes
    1 Dr Nico Reinsch and Dr Anna Füting contributed equally to the study and the manuscript.
    Affiliations
    Department of Electrophysiology, Alfried Krupp Krankenhaus, Essen, Germany

    Department of Medicine, Witten/Herdecke University, Witten, Germany
    Search for articles by this author
  • Author Footnotes
    1 Dr Nico Reinsch and Dr Anna Füting contributed equally to the study and the manuscript.
    Anna Füting
    Footnotes
    1 Dr Nico Reinsch and Dr Anna Füting contributed equally to the study and the manuscript.
    Affiliations
    Department of Electrophysiology, Alfried Krupp Krankenhaus, Essen, Germany

    Department of Medicine, Witten/Herdecke University, Witten, Germany
    Search for articles by this author
  • Dennis Höwel
    Affiliations
    Department of Electrophysiology, Alfried Krupp Krankenhaus, Essen, Germany

    Department of Medicine, Witten/Herdecke University, Witten, Germany
    Search for articles by this author
  • John Bell
    Affiliations
    Department of Electrophysiology, Alfried Krupp Krankenhaus, Essen, Germany

    Department of Medicine, Witten/Herdecke University, Witten, Germany
    Search for articles by this author
  • Yali Lin
    Affiliations
    Department of Electrophysiology, Alfried Krupp Krankenhaus, Essen, Germany

    Department of Medicine, Witten/Herdecke University, Witten, Germany
    Search for articles by this author
  • Kars Neven
    Affiliations
    Department of Electrophysiology, Alfried Krupp Krankenhaus, Essen, Germany

    Department of Medicine, Witten/Herdecke University, Witten, Germany
    Search for articles by this author
  • Author Footnotes
    1 Dr Nico Reinsch and Dr Anna Füting contributed equally to the study and the manuscript.

      Background

      Pulsed field ablation (PFA) is a novel, nonthermal ablation modality that can ablate myocardial tissue with minimal effects on surrounding tissue. Preclinical data show an absence of cerebral emboli after extensive PFA. However, clinical data on silent cerebral lesions (SCLs) and/or silent cerebral events (SCEs) after PFA are lacking.

      Objectives

      The purpose of this study was to investigate the occurrence of neurological deficits and SCL and/or SCE after PFA in paroxysmal atrial fibrillation (AF) using National Institutes of Health Stroke Scale (NIHSS) scores and magnetic resonance imaging (MRI).

      Methods

      In patients with symptomatic paroxysmal AF, pulmonary vein isolation (PVI) using PFA was performed. NIHSS scores were assessed before and 2 days and 30 days after PVI. One day after PVI, patients underwent cerebral 1.5-T MRI scanning using diffusion-weighted imaging and fluid–attenuated inversion recovery sequences to document the occurrence of SCL/SCE.

      Results

      PFA was performed in 30 patients (age 63 ± 10 years). No patient showed neurological deficits. All NIHSS scores showed the minimum value of 0. Cerebral MRI scans were normal in 29 of 30 patients (97%). In 1 patient (3%), a single 7-mm cerebellar lesion was observed. Forty days after the procedure, follow-up cerebral MRI scan showed complete regression of the lesion.

      Conclusion

      In patients treated with PFA for symptomatic paroxysmal AF, the incidence of MRI-detected asymptomatic thromboembolic cerebral events or lesions was as low as 3%. No neurological deficits occurred in any of the patients.

      Keywords

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