Silent Cerebral Embolism Following Left Ventricular Endocardial Ablation: The Silver Study

Endocardial ventricular ablation is frequently used to manage premature ventricular complexes (PVCs) and idiopathic ventricular tachycardias (VTs); however, data regarding new silent cerebral embolism (SCE) during this procedure are quite limited. This prospective study sought to determine the incidence and potential risk factors of SCE in patients who underwent left ventricular (LV) ablation for PVCs or idiopathic VTs.

A total of 37 [male:15 (40.5%), mean age:52.27 ± 14.31years] patients who underwent treatment of endocardial ventricular ablation at our institution between August 2022 and January 2024 were included. Baseline data, arrhythmia characteristics (PVC/VT), and procedural details were prospectively evaluated. The primary endpoint was defined as a new SCE after the procedure. All patients were evaluated with diffusion-weighted magnetic resonance imaging (DW-MRI) before and after the procedure within 24 h.

Right ventricular (RV) and LV endocardial ablation was performed in 10 (VT, n = 1, PVC, N = 9) and 27 patients (VT, n = 3, PVC, n = 24), respectively. At least 1 new SCE detected by DW-MRI was observed in 6 patients (22.2%) in the LV ablation group, while no SCE was detected in the RV ablation group (p = 0.162). Patients with high CHA₂DS₂-VASc scores [relative risk (RR): 1.720, p = 0.047] and elevated N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels (RR: 1.002, p = 0.013) had a higher risk of SCE among LV ablation patients.

Patients who underwent LV ablation for PVC/VT with high CHA₂DS₂-VASc scores and elevated NT-proBNP levels may be at increased risk of SCE.