Incidence of brain lesions following pulsed field ablation for atrial fibrillation

Cerebral embolisms are a potential complication of atrial fibrillation ablation. Pulsed field ablation (PFA) is a novel, nonthermal, and tissue-specific ablation technology. There are limited clinical data on the neurologic safety of this new ablation technique.

The aim of our study was to analyze the incidence of brain injuries in patients undergoing pulmonary vein isolation (PVI) with PFA.

Forty-five patients with symptomatic paroxysmal and persistent atrial fibrillation who underwent PVI with PFA were included. At 24 hours after the procedure, patients underwent a 1.5T brain magnetic resonance imaging (MRI) scan to detect new ischemic or hemorrhagic brain lesions.

Three patients (6.7%; 95% confidence interval [CI], 1.4%-18.3%) showed new lesions on the brain MRI scan. One patient (2.2%; 95% CI, 0.1%-11.8%) experienced a transient ischemic attack with mixed aphasia, recovering within the next 24 hours, and 2 patients (4.4%; 95% CI, 0.5%-15.1%) had silent cerebral lesions (SCLs). Patients with brain lesions exhibited a significantly larger left atrial volume than those without lesions. In the 2 patients with SCL, lesion resolution was confirmed on the follow-up MRI scan.

This study demonstrated an incidence of SCL comparable to previous reports in patients undergoing PVI with PFA technology. Left atrial dilation was the only factor associated with the occurrence of SCL after ablation.