Cerebrovascular Ischemic Lesions After Pulsed Field Ablation for Atrial Fibrillation Using Variable-Loop Ablation...

Area of Science:

• Cardiology
• Neurology
• Medical Devices

Background:

• Pulsed field ablation (PFA) is a growing technology for treating atrial fibrillation (AF).
• Limited data exists on ischemic cerebral lesions (ICLs) following PFA.
• Cerebral safety must be evaluated for each unique PFA system due to varying pulse characteristics.

Purpose of the Study:

• To determine the incidence of ICLs after PFA for AF using a specific variable-loop circular catheter.
• To assess the safety profile of this PFA system in AF patients.

Main Methods:

• Prospective, observational, single-center cohort study.
• 21 patients with nonparoxysmal AF underwent pulmonary vein and left atrial posterior wall isolation.
• Brain MRI (including diffusion-weighted imaging) was performed before and after the procedure to detect acute ICLs.

Main Results:

• ICLs were observed in 66.7% of patients (14 out of 21).
• A median of 2 lesions per patient and a median cumulative lesion burden of 10.5 mm were recorded.
• Over half of the lesions were located in the posterior brain territory; one major stroke occurred.

Conclusions:

• PFA with the studied variable-loop circular catheter demonstrated a high rate of ICLs.
• The posterior cerebrovascular territory was the most common site for these lesions.
• Early termination of the study due to safety concerns highlights the need for caution.