Comparative Study Of The Incidence Of Asymptomatic Cerebral Embolism In Patients With Atrial Fibrillation After Cryoablation And Radiofrequency Ablation

BackgroundAtrial fibrillation?AF?is the most common arrhythmia,accounting for 1%of the population.Its prevalence increases with age.The prevalence of adults under 55 is<0.1%and The prevalence rate of 80 years and older is about 8%.The aging of the population structure will increase the prevalence of atrial fibrillation.Data from the Framingham study showed a three to five-fold increase in stroke risk in AF patients.AF aggravates heart function deterioration and reduces life treatment.More and more patients choose catheter ablation?CA?to restore sinus rhythm.CA has been shown to be safe and effective in the treatment of symptomatic atrial fibrillation.The success rate of catheter ablation varies with the experience and strategy.The complication rate is approximately 2%-5%.In recent years,symptomatic stroke has been found to be only a small number of cerebral ischemic events.Brain magnetic resonance imaging after atrial fibrillation catheter ablation suggests that up to 50%of cases have new lesions without significant neurological symptoms.There is no obvious neurological impairment and the head MRI is positive.It is called Asymptomatic Cerebral Embolism?ACE?or silent brain infarction?SBI?.ACE may aggravate cognitive decline and increase the incidence of mental illness,but it can also serve as a“fingerprint”for interventional procedures to identify embolisms that may be caused by cardiovascular interventions,thereby optimizing equipment and surgical procedures,and further reducing perioperative periods.Compared with cerebral infarction caused by atrial fibrillation,there may be more embolism in new ACE after AFCA,including thrombosis,gas,tissue,and fat.In recent years,experts have speculated that the continuous anticoagulant therapy during the perioperative period of ablation makes the anticoagulant environment more stable,however,the bridging scheme that relies on intermittent heparin administration and intermittent monitoring of ACT may aggravate the instability of anticoagulation.If INR?2.0 at the time of surgery,uninterrupted oral vitamin K antagonist?VKA?or continuous oral administration of new oral anticoagulants?NOACs?can reduce the incidence of asymptomatic cerebral embolism.Recent studies have also confirmed that continuous oral anticoagulant therapy during AFCA perioperative surgery can reduce the incidence of ACE.Pulmonary vein isolation is the standard procedure for atrial fibrillation ablation.Among them,cryoballoon catheter ablation?CBCA?and radiofrequency catheter ablation?RFCA?are the most widely used.Clinical studies of ACE are still rare and are small samples.And with the development and application of NOACs,the incidence of asymptomatic cerebral infarction will also change.ObjectiveThis prospective randomized controlled trial compared the incidence of new-onset ACE between CBCA and RFCA in patients with atrial fibrillation during perioperative uninterrupted NOACs,and explored risk factors for AFCA-associated ACE.MethodsWe enrolled 100 AF patients who met the inclusion and exclusion criteria.They underwent a 3.0T magnetic resonance examination,left atrial CTA,esophageal ultrasound before ablation.And we also collected general medical history data.They were randomly divided into the cryoballoon group and the radiofrequency group,50cases in each group.The head skull 3.0T magnetic resonance examination was performed 24 hours after the operation,and the neuropsychiatric clinical symptoms were observed.They were continuous oral anticoagulant therapy during perioperative period.Results1.There was no statistical difference between the two groups.The intraoperative and postoperative parameters:intraoperative heparin dose,intraoperative average ACT,intraoperative cardioversion,and preoperative MRI found no significant difference between the two groups.There were 19 cases?19.0%?with new asymptomatic cerebral embolism,including 11 cases?22.0%?in the cryoballoon group and 8 cases?16.0%?in the radiofrequency group,P=0.444>0.05.The cryoballoon ablation group and RF could not be considered that the probability of asymptomatic cerebral embolism was different.There were no cases of cerebral infarction with neurological dysfunction after operation.3.In multivariate logistic regression analysis,persistent atrial fibrillation?OR=9.296,95%CI 1.863⁴6.380,P=0.007?and higher score of CHA₂DS₂-VASc score?OR=2.083,95%CI 1.121³.872,P=0.020?are risk factors for new asymptomatic cerebral embolism after atrial fibrillation catheter ablation.Conclusion1.There was no significant difference in the incidence of ACE between cryoballoon catheter ablation and radiofrequency catheter ablation with uninterrupted perioperative oral anticoagulation strategy used NOACs;2.Persistent atrial fibrillation and higher score of CHA₂DS₂-VASc score is a risk factor for new asymptomatic cerebral embolism after atrial fibrillation catheter ablation.