Po-02-004 incidence of post-ablation cerebral lesions: a comparison of pulmonary vein isolation using pulsed field ablation vs. radiofrequency energy

Pulmonary vein isolation (PVI) utilizing pulsed electric fields is a novel, nonthermal ablative modality in which subsecond electric fields can ablate myocardial tissue with minimal effects on surrounding tissue for atrial fibrillation. Any ablation technique has a potential risk for periprocedural cerebral complications, but limited data are available on the incidence of symptomatic and silent cerebral events after pulsed field ablation (PFA). The purpose of this prospective observational study was to clarify the incidence of magnetic resonance imaging (MRI)-detected acute brain lesions after PFA or radiofrequency catheter ablation (RFCA) and possible differences in target value of activated clotting time (ACT). All paroxysmal atrial fibrillation (PAF) patients (n=28, mean age 62±11 years) underwent PVI. Direct oral anticoagulation was stopped 1 days before intervention and continued by the night after operation. Cerebral 3.0T MRI scanning using diffusion-weighted imaging and fluid–attenuated inversion recovery sequences was performed within 48 hours after ablation. There was no difference in baseline characteristics and ablation procedure between two arms except history of diabetes and coronary artery disease (Figure 1A). The MRI depicted acute cerebral infarctions in 5 patients (35.7%, 1.8 lesions per case), either symptomatic (n=3, 60%) or asymptomatic (n=2, 40%) in the PFA group, statistically significant difference between the group treated by RFCA (0%, p=0.004). No patients developed cerebral hemorrhage. The lower intraprocedural ACT target than the guidelines recommendation may not increase the acute brain events. However, we may achieve higher ACTs than RFCA during PFA procedure.