Incidence of silent cerebral lesions during pulsed field ablation for paroxysmal atrial fibrillation.
Peiqi Ding, Wensu Chen, Jianfan Shen et al.
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In 30 seconds
This prospective pilot randomised controlled trial compared silent cerebral lesions (SCLs) after pulsed field ablation (PFA) versus radiofrequency catheter ablation (RFCA) in 62 patients with paroxysmal atrial fibrillation. Brain MRI was performed before and 24–48 hours after ablation. New lesions without neurological deficits were found in 12.90% (4/31) of the PFA group and 6.45% (2/31) of the RFCA group; the difference was not statistically significant (p = 0.67). Univariate analyses also linked several cardiac dimensions and procedural times with SCL status.
Key findings
- Post-procedure SCLs occurred in 12.90% (4/31) after PFA and 6.45% (2/31) after RFCA.
- The between-group difference in SCL incidence was not statistically significant (p = 0.67).
- Left atrium dimension, left atrial operation time, left ventricular end-diastolic dimension, and total operation time were higher in the SCL group in univariate analyses.
Why it matters
MRI-detected cerebral lesions are a potential complication of atrial fibrillation ablation, even without neurological deficits. This small randomised comparison provides perioperative imaging data for both techniques, but its results do not establish a difference in cerebral safety. The numerical imbalance and exploratory associations with procedural measures identify questions for further evaluation.
What to keep in mind
This was a pilot trial with 62 patients and only six detected SCLs, limiting the ability to identify between-group differences or establish risk factors.