ArticleEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2023
Incidence and predictors of stroke and silent cerebral embolism following very high-power short-duration atrial fibrillation ablation.
Article in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed.
- Initial clinical experience with the balloon-in-basket pulsed field ablation system: acute results of the VOLT CE mark feasibility study.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Trial
- Procedural Efficiency and Clinical Outcomes of a Region-Specific Radiofrequency Ablation Strategy for Pulmonary Vein Isolation.Journal of arrhythmia · 2026Article
- Early Diffusion-Weighted Imaging Lesions and Clinical Outcomes after Carotid Artery Stenting in Symptomatic Patients: A Single-Center Retrospective Study.Neurointervention · 2026Article
- Comparative analysis of therapeutic strategies in atrial fibrillation patients with left atrial appendage thrombus despite optimal NOAC therapy.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- Silent brain infarcts after major cardiac interventions: a retrospective paired cohort study using high-resolution DW-MRI.BMC cardiovascular disorders · 2026Article
- Long-term effectiveness and safety of ablation index-guided high-power ablation combined with impedance spike cut-off in patients with atrial fibrillation.Postepy w kardiologii interwencyjnej = Advances in interventional cardiology · 2025Article
- Impact of Pulsed-Field Ablation on the Left Atrial Appendage Diameter-Insights From Intra-Procedural Echocardiography.Journal of cardiovascular electrophysiology · 2025Observational
- Comparison of room times between pulsed-field ablation and very high-power short-duration ablation.Heart rhythm O2 · 2025Article
- Temperature-guided high and very high-power short duration ablation for atrial fibrillation treatment: the peQasus multicentre study.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Article
- Clinical and subclinical acute brain injury caused by invasive cardiovascular procedures.Nature reviews. Cardiology · 2025Review
- Clinical impact of very high-power-short-duration catheters on biomarkers after atrial fibrillation ablation.Journal of arrhythmia · 2025Article
- Overcoming NOAC-resistant left atrial appendage thrombus in atrial fibrillation: clinical gaps and therapeutic insights.Frontiers in cardiovascular medicine · 2025Review
- High-power short-duration setting prevents changes of periprocedural thrombotic markers and the onset of silent stroke in patients with atrial fibrillation.Heart rhythm O2 · 2024Article
- Microembolizations in the arterial cerebral circulation during atrial fibrillation ablation: cryoballoon technique advantages and neurocognitive safety-results of a prospective observational study.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Observational
- Ablation Parameters Predicting Pulmonary Vein Reconnection after Very High-Power Short-Duration Pulmonary Vein Isolation.Journal of cardiovascular development and disease · 2024Article
- Adherence to the CLOSE Protocol and Low Baseline Generator Impedance Are Independent Predictors of Durable Pulmonary Vein Isolation.Journal of clinical medicine · 2024Article
- Combined complex electrophysiological interventions due to improved standardization and efficiency: proof of concept.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Article
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14 authors.
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Abstract
aimsCerebral thrombo-embolism is a dreaded complication of pulmonary vein isolation (PVI) for atrial fibrillation; its surrogate, silent cerebral embolism (SCE) can be detected by diffusion-weighted brain magnetic resonance imaging (bMRI). Initial investigations have raised a concern that very high-power, short-duration (vHPSD; 90 W/4 s) temperature-controlled PVI with the QDOT Micro catheter may be associated with a higher incidence of SCE compared with low-power long-duration ablation. We aimed to assess the incidence of procedural complications of vHPSD PVI with an emphasis on cerebral safety. METHODS AND
resultsWe enrolled 328 consecutive patients undergoing their PVI procedure using vHPSD. A subgroup of 61 consecutive patients underwent diffusion-weighted bMRI within 24 h of the procedure, and incidence and predictors of SCE were studied. The mean procedure time and left atrial dwell time for the overall cohort were 69.6 ± 24.1 and 46.5 ± 21.5 min, respectively. First-pass isolation was achieved in 82%. No stroke or transient ischaemic attack occurred. Silent cerebral embolism was identified in 5 of 61 patients (8.2%). Silent cerebral embolism following procedures was significantly associated with lower baseline generator impedance (105.8 vs. 112.6 Ω, P < 0.0001) and with intermittent loss of catheter-tissue contact during ablation (14.1% vs. 6.1%, P < 0.0001).
conclusionVery high-power, short-duration PVI is a safe technique with an excellent acute success rate. Silent cerebral embolism incidence in our cohort was below the previously reported range, with no clinically overt cerebral complications. Lower baseline generator impedance and loss of contact during ablation may contribute to a higher risk of SCEs.
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