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

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

OBJECTIVES:

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.

METHODS:

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).

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 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).

CONCLUSION:

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.

• Authors: Kohki Nakamura, Takehito Sasaki, Yutaka Take, Kentaro Minami, Mitsuho Inoue, Shohei Kishi, Shingo Yoshimura, Wataru Sasaki, Yoshinori Okazaki, Hiroyuki Motoda, Katsura Niijima, Yuko Miki, Koji Goto, Eiji Yamashita, Keiko Koyama, Nobusada Funabashi, Shigeto Naito
• Journal: Heart rhythm (Heart Rhythm) Vol. 17 Issue 2 Pg. 250-257 (02 2020) ISSN: 1556-3871 [Electronic] United States
• PMID: 31518721 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Atrial Appendage (diagnostic imaging, surgery)
• Atrial Fibrillation (complications, diagnosis, physiopathology, surgery)
• Female
• Follow-Up Studies
• Heart Atria (diagnostic imaging, physiopathology)
• Humans
• Incidence
• Intracranial Embolism (epidemiology, etiology)
• Japan (epidemiology)
• Male
• Prospective Studies
• Tomography, X-Ray Computed (methods)