Fehmi Keçe

Chapter 3 80 Table 2. Procedural Details. PVAC -Gold (n=35) TC (n=35) P-value TEE prior to ablation 1 (3) 6 (17) 0.053 Procedural time (min) 149±34 207±44 <0.001 Ablation time (min) 28±9 48±12 <0.001 INR day of ablation 2.8±0.6 2.6±0.4 0.066 SR before ablation 30 (86) 28 (80) 0.526 Mean ACT during procedure (s) 369±26 378±24 0.118 ACT before energy delivery (s) 377±32 370±32 0.280 Minimum measured ACT (s) 337±47 348±41 0.286 Total administered heparin during procedure (IE) 8357±2095 8071±2579 0.613 ECV during procedure 5 (14) 12 (34) 0.051 Deep sedation 29 (83) 29 (83) 1.000 Postprocedural time to MRI (hours) 25±17 28±19 0.589 Values are mean±standard deviation or n (%). ACT: activated clotting time, ECV: electro cardio version, INR: international normalized ratio, MRI: magnetic resonance imaging, SR: sinus rhythm, TEE: transesophageal echocardiography, PVAC- Gold: Pulmonary Vein Ablation Catheter-Gold, TC: Thermocool. 3.3.3 Cerebral Embolism All patients underwent pre- and post-procedural MRI and no patients were excluded due to missing data. At pre-procedural MRI, 42 (60%) patients had white matter lesions, 25 PVAC-Gold and 17 Thermocool (p=0.087) with modified Fazekas scores of 0.7±0.6 and 0.7±0.8 (p=0.725), respectively. Ten Patients (5 in each group) had a previous infarction. In 8 patients the previous infarction was asymptomatic. MRI at a median of 21 (IQR 18-25) hours after ablation showed 16 new cerebral lesions in 8 (23%) patients (7 patients with cerebral infarction) of the PVAC-Gold group compared to 2 ACE in 2 (6%) patients (no cerebral infarction) of the Thermocool group (p=0.042, Figure 1). One patient in the PVAC-Gold group experienced symptomatic diplopia with corresponding embolism in the nucleus of the oculomotor nerve. Symptoms resolved a few hours after ablation. At follow-up MRI, 6 out of 16 (38%) ACE in 4 (11%) patients in the PVAC-Gold group but none in the Thermocool group persisted as cerebral infarcts. Figure 2 shows an example of a patient with 4 cerebral lesions. Details about lesion size and location are described in Supplementary table B. In the PVAC-Gold group, there was no significant difference in the total number of MES between patients with and without cerebral lesions. There was no relation between peri-procedural ECV and