Fehmi Keçe

Cerebral Embolism during Atrial Fibrillation Ablation 75 3 3.1 Introduction The Pulmonary Vein Ablation Catheter (PVAC; Medtronic Inc., Minneapolis, MN, USA) is a multipolar, non-cooled, duty-cycled radiofrequency (RF) device for pulmonary vein isolation (PVI). Although short procedure times with similar effectiveness compared to cooled point- by-point RF ablation were described (1), the reported incidence of asymptomatic cerebral embolism (ACE) up to 42% on cerebral magnetic resonance imaging (MRI) raised significant concern (2-4). Subsequent studies suggested temperature overshoot during intermittent tissue contact and electrical short-circuit between electrodes 1 and 10 as the main causes (5,6). Accordingly, the nine electrode PVAC-Gold was developed to prevent these issues, which led to a 2.1% incidence of ACE (7). This study lacked a control group however and the ACE definition did not comply with international consensus (3). Nonetheless, the clinical significance of ACE remains unclear (8,9). The main purpose of this study was to randomly compare the ACE incidence between PVAC-Gold and irrigated RF catheter. The second aim was to deepen the understanding of ACE by analysis of trans-cranial Doppler and coagulation parameters. The third aim was to evaluate the clinical significance of ACE with neuropsychological tests.