The Incidence of Cerebral Micro Thromboembolism after AF Ablation Guided by CFAE

Abstract

Background: Some reports demonstrated that cerebral thromboembolism after pulmonary vein isolation (PVI) occurred 10–20%. Complex fractionated atrial electrograms (CFAE) guided ablation requires ablation of more areas in the left atrium (LA) than PVI and the more complications may be concerned. We sought to investigate the incidence of cerebral thromboembolism after CFAE ablation using diffusion-weighted magnetic resonance imaging (DW-MRI). Methods: Our study included 100 patients who underwent catheter ablation of AF guided solely by CFAE (n=56) or combined with PVI. Irrigation catheter (the maximum power: 40 W) was used in all cases. All patients underwent cerebral DW-MRI the day after ablation. Results: The incidence of cerebral thromboembolism after AF ablation was 6%. CHADS2 score of the patients with cerebral thromboembolism was higher than that of the patients without thromboembolism (P<0.05). LA volume (LAV) was larger and left ventricular ejection fraction (LVEF) was lower in the patients with cerebral thromboembolism (P<0.05, P<0.01, respectively). In the multivariable analysis, LAV (P<0.05) and LVEF (P<0.05) could be predictors of cerebral thromboembolism after CFAE ablation. Conclusion: The incidence of cerebral thromboembolism after CFAE ablation was not greater compared with previous reports. More cautious management during AF ablation to avoid thrombosis is required especially in the patients with low LVEF and large LAV.