Incidence and Long-Term Follow-Up of Silent Cerebral Lesions After Pulmonary Vein Isolation Using a Remote Robotic Navigation System as Compared With Manual Ablation
| Autor: | Andreas Rillig, Ulrich Fink, Vlada Zvereva, Tomislav Miljak, Peter Wohlmuth, Jochen Talazko, Bajram Hajredini, Roland Richard Tilz, Werner Jung, Anita Arya, Udo Meyerfeldt, Ralf Birkemeyer |
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| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty Robotic navigation Time Factors Subarachnoid hemorrhage medicine.medical_treatment Asymptomatic Pulmonary vein Electrocardiography Heart Conduction System Risk Factors Germany Physiology (medical) Atrial Fibrillation medicine Humans Prospective Studies Prospective cohort study Aged business.industry Incidence Incidence (epidemiology) Atrial fibrillation Equipment Design Robotics Middle Aged medicine.disease Ablation Magnetic Resonance Imaging Surgery Stroke Treatment Outcome Pulmonary Veins Catheter Ablation Female medicine.symptom Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | Circulation: Arrhythmia and Electrophysiology. 5:15-21 |
| ISSN: | 1941-3084 1941-3149 |
| Popis: | Background— The incidence of silent cerebral lesions (SCL) after atrial fibrillation (AF) ablation is highly variable, depending on the technology used. Recently, an increased risk for SCL has been described for a novel, nonirrigated ablation tool using multielectrode phased radiofrequency (PVAC). The aim of this prospective study was to evaluate the incidence and long-term follow-up of SCL in patients undergoing robotically assisted pulmonary vein isolation (RA-PVI) as compared with manual PVI. Methods and Results— Circumferential PVI using irrigated radiofrequency current was performed on 70 patients (41 patients with paroxysmal AF, 59%). Fifty patients underwent RA-PVI and 20 patients underwent a manual approach. Cerebral MRI was performed the day before and the day after the ablation procedure; follow-up MRI was performed on 9 of 12 (75%) patients after a follow-up period of 21 months. SCLs were found in 12 of 70 (17%) patients in this study; the incidence of SCLs was similar in patients undergoing RA-PVI as compared with manually ablated patients (n=9, 18% versus n=3, 15%; probability value=1.0). In 1 patient undergoing manual PVI (1%), an SCL with asymptomatic subarachnoid hemorrhage was detected; the bleeding completely resolved within 1 month. Transient ischemic attack occurred in 1 (1%) patient 2 days after manual PVI. After a median follow-up period of 21 months, no residual SCLs were detected. Conclusions— The incidence of SCL using the robotic navigation system was 18% in this study. Incidence and size of SCL appears to be similar after RA-PVI as compared with manual PVI. Repeat MRI showed no residual SCLs at long-term follow-up. |
| Databáze: | OpenAIRE |
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