Impact of high-power short-duration atrial fibrillation ablation technique on the incidence of silent cerebral embolism: a prospective randomized controlled study

作者全名："Chen, Wei-Jie; Gan, Chun-Xia; Cai, Yang-Wei; Liu, Yang-Yang; Xiao, Pei-Lin; Zou, Li-Li; Xiong, Qing-Song; Qin, Fang; Tao, Xie-Xin; Li, Ran; Du, Hua-An; Liu, Zeng-Zhang; Yin, Yue-Hui; Ling, Zhi-Yu"

作者地址："[Chen, Wei-Jie; Gan, Chun-Xia; Cai, Yang-Wei; Xiao, Pei-Lin; Zou, Li-Li; Xiong, Qing-Song; Qin, Fang; Tao, Xie-Xin; Li, Ran; Du, Hua-An; Liu, Zeng-Zhang; Yin, Yue-Hui; Ling, Zhi-Yu] Chongqing Med Univ, Affiliated Hosp 2, Dept Cardiol, 288 Tianwen Ave, Chongqing 400060, Peoples R China; [Liu, Yang-Yang] Chongqing Med Univ, Affiliated Hosp 2, Dept Radiol, Chongqing, Peoples R China"

通信作者："Ling, ZY (通讯作者)，Chongqing Med Univ, Affiliated Hosp 2, Dept Cardiol, 288 Tianwen Ave, Chongqing 400060, Peoples R China."

来源：BMC MEDICINE

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001109169500004

JCR分区：Q1

影响因子：9.3

年份：2023

卷号：21

期号：1

开始页：　

结束页：　

文献类型：Article

关键词：Atrial fibrillation; Catheter ablation; High-power short-duration; Silent cerebral embolism; High-resolution diffusion-weighted magnetic resonance imaging

摘要："BackgroundHigh-power short-duration (HPSD) ablation strategy has emerged as a popular approach for treating atrial fibrillation (AF), with shorter ablation time. The utilized Smart Touch Surround Flow (STSF) catheter, with 56 holes around the electrode, lowers electrode-tissue temperature and thrombus risk. Thus, we conducted this prospective, randomized study to investigate if the HPSD strategy with STSF catheter in AF ablation procedures reduces the silent cerebral embolism (SCE) risk compared to the conventional approach with the Smart Touch (ST) catheter.MethodsFrom June 2020 to September 2021, 100 AF patients were randomized 1:1 to the HPSD group using the STSF catheter (power set at 50 W) or the conventional group using the ST catheter (power set at 30 to 35 W). Pulmonary vein isolation was performed in all patients, with additional lesions at operator's discretion. High-resolution cerebral diffusion-weighted magnetic resonance imaging (hDWI) with slice thickness of 1 mm was performed before and 24-72 h after ablation. The incidence of new periprocedural SCE was defined as the primary outcome. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) test.ResultsAll enrolled AF patients (median age 63, 60% male, 59% paroxysmal AF) underwent successful ablation. Post-procedural hDWI identified 106 lesions in 42 enrolled patients (42%), with 55 lesions in 22 patients (44%) in the HPSD group and 51 lesions in 20 patients (40%) in the conventional group (p = 0.685). No significant differences were observed between two groups regarding the average number of lesions (p = 0.751), maximum lesion diameter (p = 0.405), and total lesion volume per patient (p = 0.669). Persistent AF and CHA2DS2-VASc score were identified as SCE determinants during AF ablation procedure by multivariable regression analysis. No significant differences in MoCA scores were observed between patients with SCE and those without, both immediately post-procedure (p = 0.572) and at the 3-month follow-up (p = 0.743).ConclusionsInvolving a small sample size of 100 AF patients, this study reveals a similar incidence of SCE in AF ablation procedures, comparing the HPSD strategy using the STSF catheter to the conventional approach with the ST catheter.Trial registrationClinicaltrials.gov: NCT04408716.Graphical AbstractAF = Atrial fibrillation, DWI = Diffusion-weighted magnetic resonance imaging, HPSD = High-power short-duration, ST = Smart Touch, STSF = Smart Touch Surround Flow."

基金机构：Natural Science Foundation Project of Chongqing; Department of Radiology at the Second Affiliated Hospital of Chongqing Medical University

基金资助正文："We sincerely appreciate the patients who participated in the research, making it possible to achieve our objectives. We also sincerely thank the entire team of Department of Radiology at the Second Affiliated Hospital of Chongqing Medical University for their support of this study."