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Pulmonary vein isolation (PVI) with a multielectrode phased radiofrequency pulmonary vein ablation catheter (PVAC) presents a high risk of subclinical intracranial embolic lesions, according to a study1 published recently in the Journal of the American College of Cardiology.

Dr Claudia Herrera Siklódy and colleagues (Bad Krozingen Heart Centre, Germany) compared the results of PVI with PVAC to those of PVI with conventional irrigated radiofrequency (RF) and cryoballoon in patients with symptomatic atrial fibrillation (AF).  The study was designed to include 240 patients referred for PVI (80 from each ablation group) based on a statistical power of 0.8 to detect an incidence of embolic events 25% higher in any group compared with the others.

The study was terminated in agreement with the ethics committee after the first interim analysis because the incidence of embolic events in the PVAC group was already significantly higher.  Post-procedure magnetic resonance imaging of the 74 patients included at that point showed a single new embolic lesion in 7.4% of the irrigated RF patients, and 4.3% of the cryoballoon group.  In the PVAC group, however, 37.5% of patients exhibited 2.7 ± 1.3 new lesions each.

The authors state that, although not randomised, their study groups each had a similar clinical thromboembolic risk profile and received the same degree of anticoagulation during the procedure, meaning the results were likely catheter specific.  They speculate that intensified anticoagulation or additional platelet inhibition could reduce the embolic rate while using PVAC technology, but may also increase bleeding risk.  They assert that “improvement in PVAC technology and further studies to clarify the origin of these embolic lesions are mandatory to reduce the rate of silent embolisms during ablation procedures”.


1 Siklódy CH, Deneke T, Hocini M, et al.  Incidence of asymptomatic intracranial embolic events after pulmonary vein isolation: comparison of different atrial fibrillation ablation technologies in a multicenter study. JACC 2011;58 doi:10.1016/j.jacc.2011.04.010.

Published on: August 2, 2011

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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