Real-time detection of microembolic signals using carotid echocardiography: A comparative study of 3 pulsed-field...

Silent cerebral events/lesions (SCEs/SCLs) have been reported in approximately 20% of patients undergoing catheter ablation for atrial fibrillation. Currently, 3 types of pulsed-field ablation (PFA) systems are available in Japan. However, the incidence of microembolic signals (MESs) during PFA has not been fully investigated.

This study compared the number of MESs observed during procedures performed on each of the 3 PFA systems.

Thirty-three patients who underwent PFA were included (FARAPULSE in 11, PulseSelect in 11, and VARIPULSE in 11). Carotid echocardiography was used throughout the procedure to monitor real-time vascular parameters, whereas cerebral magnetic resonance imaging was performed 1 day after the procedure. Pulmonary vein (PV) isolation was performed at the ostium and antrum, according to the recommended number of energy applications.

During PV isolation, the number of MESs was significantly lower in FARAPULSE than in PulseSelect (61 ± 45 vs 472 ± 337, P = .01) and VARIPULSE (61 ± 45 vs 858 ± 266, P < .001). Across all PVs, VARIPULSE consistently generated more MESs than FARAPULSE. VARIPULSE generated more MESs in the inferior PVs than PulseSelect. Although PulseSelect showed a higher incidence of MES during PFA of the left superior PV, the MES count decreased during the subsequent 3 PVs. With VARIPULSE, multiple SCEs/SCLs occurred in 4 patients (36%). Only 1 patient in the FARAPULSE group had an SCE. No SCEs/SCLs were observed in PulseSelect.

VARIPULSE demonstrated a significantly higher incidence of MESs than FARAPULSE. PulseSelect produced the highest number of MESs during the initial application. Multiple SCEs/SCLs were exclusively observed with VARIPULSE.