TY - JOUR
T1 - Comparison of cerebral safety after atrial fibrillation using pulsed field and thermal ablation
T2 - Results of the neurological assessment subgroup in the ADVENT trial
AU - Patel, Chinmay
AU - Gerstenfeld, Edward P.
AU - Gupta, Sanjaya K.
AU - Winterfield, Jeffrey
AU - Woods, Christopher
AU - Natale, Andrea
AU - Schneider, Christopher W.
AU - Achyutha, Anitha B.
AU - Holland, Scott K.
AU - Richards, Elizabeth
AU - Albrecht, Elizabeth M.
AU - Lehmann, John W.
AU - Mansour, Moussa
AU - Reddy, Vivek Y.
N1 - Publisher Copyright:
© 2024 Heart Rhythm Society
PY - 2024/11
Y1 - 2024/11
N2 - Background: Atrial fibrillation (AF) ablation carries the risk of silent cerebral event (SCE) and silent cerebral lesion (SCL). Although “silent,” these may have long-term clinical implications and are challenging to study as postprocedural magnetic resonance imaging (MRI) is not standard of care. Objective: The neurological assessment subgroup (NAS) of ADVENT compared cerebral effects of pulsed field ablation (PFA) with standard-of-care thermal ablation. Methods: The NAS included consecutive randomized PFA and thermal ablation patients who received postprocedural brain MRI 12–48 hours after ablation. Patients with apparent SCE or SCL findings underwent a modified Rankin scale assessment. MRI images were subsequently reviewed by a blinded brain imaging core laboratory. Results: In total, 77 patients with paroxysmal AF were enrolled at 6 centers; 71 had analyzable scans (34 PFA; 37 thermal ablation). Through individual center review, 6 PFA and 4 thermal scans were identified as SCE/SCL positive, of which 3 PFA and 0 thermal SCE/SCL findings were confirmed by a blinded core laboratory. MRI findings revealed 1 patient with 2- to 4-mm SCEs, 1 patient with a 3-mm SCE, and 1 patient with 2 SCLs (5.5 mm and 11 mm). All modified Rankin scale and National Institutes of Health Stroke Scale scores were 0 before discharge and at 90-day follow-up. There were only 2 neurological safety events (1 transient ischemic attack [PFA] and 1 stroke [thermal ablation]) in the ADVENT study, neither of which was part of the NAS. Conclusion: The ADVENT trial provides the first prospective, randomized data on the cerebral impact of PFA and thermal ablation of AF. Incidence of SCE/SCL after ablation in the NAS was low.
AB - Background: Atrial fibrillation (AF) ablation carries the risk of silent cerebral event (SCE) and silent cerebral lesion (SCL). Although “silent,” these may have long-term clinical implications and are challenging to study as postprocedural magnetic resonance imaging (MRI) is not standard of care. Objective: The neurological assessment subgroup (NAS) of ADVENT compared cerebral effects of pulsed field ablation (PFA) with standard-of-care thermal ablation. Methods: The NAS included consecutive randomized PFA and thermal ablation patients who received postprocedural brain MRI 12–48 hours after ablation. Patients with apparent SCE or SCL findings underwent a modified Rankin scale assessment. MRI images were subsequently reviewed by a blinded brain imaging core laboratory. Results: In total, 77 patients with paroxysmal AF were enrolled at 6 centers; 71 had analyzable scans (34 PFA; 37 thermal ablation). Through individual center review, 6 PFA and 4 thermal scans were identified as SCE/SCL positive, of which 3 PFA and 0 thermal SCE/SCL findings were confirmed by a blinded core laboratory. MRI findings revealed 1 patient with 2- to 4-mm SCEs, 1 patient with a 3-mm SCE, and 1 patient with 2 SCLs (5.5 mm and 11 mm). All modified Rankin scale and National Institutes of Health Stroke Scale scores were 0 before discharge and at 90-day follow-up. There were only 2 neurological safety events (1 transient ischemic attack [PFA] and 1 stroke [thermal ablation]) in the ADVENT study, neither of which was part of the NAS. Conclusion: The ADVENT trial provides the first prospective, randomized data on the cerebral impact of PFA and thermal ablation of AF. Incidence of SCE/SCL after ablation in the NAS was low.
KW - Atrial fibrillation
KW - Brain
KW - Magnetic resonance imaging
KW - Pulsed field ablation
KW - SCE/SCL
UR - http://www.scopus.com/inward/record.url?scp=85198208546&partnerID=8YFLogxK
U2 - 10.1016/j.hrthm.2024.05.048
DO - 10.1016/j.hrthm.2024.05.048
M3 - Article
C2 - 38823667
AN - SCOPUS:85198208546
SN - 1547-5271
VL - 21
SP - 2103
EP - 2109
JO - Heart Rhythm
JF - Heart Rhythm
IS - 11
ER -