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Accidente cerebrovascular embólico después de la ablación por campo pulsado para la fibrilación auricular
Kohei Sasajima1, Kazuhiro Satomi2, Yasuteru Yamauchi3
1Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
JACC. Case reports
|January 23, 2026
Resumen
La ablación por campo pulsado (PFA) para la fibrilación auricular puede causar raramente accidentes cerebrovasculares isquémicos embólicos, incluso con su mecanismo no térmico. Estos accidentes cerebrovasculares, caracterizados por múltiples infartos pequeños, justifican una mayor investigación sobre sus orígenes embólicos.
Área de la Ciencia:
- Cardiología
- Neurología
- Dispositivos Médicos
Sus antecedentes:
- La ablación por campo pulsado (PFA) es un método no térmico para tratar la fibrilación auricular, generalmente considerado más seguro que la ablación térmica.
- Informes recientes indican un riesgo potencial de accidente cerebrovascular isquémico después de los procedimientos de PFA.
Objetivo del estudio:
- Informar y analizar casos de accidente cerebrovascular isquémico que ocurren después de la PFA.
- Investigar la posible naturaleza embólica y las causas de estos accidentes cerebrovasculares post-PFA.
Principales métodos:
- Serie de casos de 5 pacientes de edad avanzada (>75 años) con puntuaciones CHA2DS2-VA altas que experimentaron accidente cerebrovascular isquémico o AIT después de la PFA.
- Revisión de neuroimagen (resonancia magnética con difusión) que muestra múltiples infartos pequeños.
- Análisis de los detalles del procedimiento, incluidos los sistemas de PFA utilizados y las terapias adyuvantes.
Principales resultados:
- Todos los 5 pacientes desarrollaron accidente cerebrovascular isquémico o AIT en la semana posterior a la PFA.
- La resonancia magnética con difusión reveló múltiples infartos cerebrales pequeños en todos los casos.
- Los resultados clínicos variaron desde la recuperación completa hasta déficits residuales leves.
Conclusiones:
- Los accidentes cerebrovasculares isquémicos posteriores a la PFA parecen ser de naturaleza embólica, como lo sugieren múltiples infartos pequeños.
- Las posibles fuentes embólicas incluyen aire/microburbujas del catéter/vainas o formación de trombos.
- Es crucial una mayor investigación para comprender y mitigar el riesgo de infarto cerebral asociado con la PFA.
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