Asymptomatic brain lesions following laserballoon-based pulmonary vein isolation

Abstract

Following laserballoon-based PVI, new asymptomatic brain lesions were detected in 11.4% of patients. A higher CHA2DS2VASc score, but not the ablation technology utilized, was the only associated risk factor.

Wide Circumferential versus Individual Isolation of Pulmonary Veins Using the Endoscopic Ablation System

“…The endoscopic ablation system (EAS, CardioFocus, Inc., Marlborough, MA, USA) incorporates a compliant balloon and a laser source that allow deployment of point‐by‐point lesions under direct visual guidance . Data on the feasibility, safety, and clinical outcome of EAS‐based PVI have recently been published . The current prospective study sought to compare wide circumferential to separate isolation of individual PVs using the EAS and assess acute procedural success, safety, and clinical outcome.…”

Innovative Approaches to Assess the Impact and Steps to Decrease the Neurological Consequences of Ablation

“…While some groups have defined the ''new MRI-detected lesion'' as a hyperintense diffusion-weighted imaging (DWI) lesion with reduced apparent diffusion coefficient (ADC) and T2-weighted fluid-attenuated inverse recovery sequence (FLAIR) positivity, 10,13-17 a few others have used a more sensitive definition without the FLAIR positivity. 11,[18][19][20][21][22][23][24][25][26] There is much controversy regarding the significance of SCLs/SCEs and their long-term consequences. In addition to the structural MRI findings, several recent studies have suggested a strong association with function, correlating SCLs/SCEs and cognitive decline, as well as dementia.…”

“…7,20,34,35 A small proportion of the lesions seem to be larger than 10 mm and seen predominantly in the cerebellum. [8][9][10][11]13,14,18,21,[36][37][38] Although most studies reporting post-AF ablation SCLs/SCEs were performed using 1.5-Tesla MRIs, one study using a 3-Tesla high-resolution MRI reported a two to three times increase in the incidence of the lesions in patients undergoing left atrial catheter ablation independent of the respective balloon-based catheter devices. The new lesions seen in this study were not associated with cognitive decline in patients after the ablation, suggesting a mere increase in the imaging sensitivity rendered by the higher spatial resolution rather than increased cerebral embolization during the procedure.…”

“…7 In most of the studies to date, post-ablation MRI to evaluate for stroke or SCLs/SCEs was performed within 48-72 h of the ablation procedure. Although no particular location was shown to be significantly more prone, some studies suggested that there might be a predilection for the middle cerebral artery 18,10 or the vertebral artery territories. 8,9,11,13,21 Importantly, this is consistent with the most common patterns seen in embolic strokes.…”

“…118 Two separate prospective studies comparing the laser balloon technology to irrigated RF and cryoballoon based pulmonary vein isolation reported no significant difference in the incidence of new SCLs/SCEs between these technologies. 18,22 However, the number of energy applications was found to be an independent predictor of SCLs/SCEs and the incidence of steam pop and thrombus formation are known to increase with catheter contact force. Innovations focused on newer balloon designs that improves tissue contact and reduce contact force may in fact reduce the risk of new SCLs/SCEs during ablation.…”