![]() ![]() Robotic magnetic navigation (RMN) employs a fundamentally different mechanism of action. Mechanical robotic navigation has previously been shown to have a similar rate of SCEs compared to manual control (MC) ablation which we hypothesize is due to the similar manual pull-wire catheter technology employed ( 12). Robotic navigation technology has emerged as an important new tool to facilitate catheter ablation of arrhythmias ( 11). A high incidence of SCEs has been reported recently using the duty-cycled phased-radiofrequency ablation tool ( 6). ![]() ![]() In the last decade, the exploration of SCE mechanisms has been focused on the risk of different AF ablation technologies and new ablation tools, which have various effects on the incidence of SCEs ( 9, 10). Several mechanisms have been suggested as being potentially responsible for SCEs after AF catheter ablation, including macrobubble development within stationary sheaths, radiofrequency- and heat- related denaturation of fibrinogen to fibrin, and catheter manipulation in the left atrium ( 8). The issue of SCEs developing perioperatively in AF patients undergoing catheter ablation was first brought to general attention by Lickfett et al. Therefore, it is imperative to take measures to reduce the risk of SCEs. The long-term clinical significance of SCEs remains unclear, however they may correlate with neurologic deficits, including an increased risk of dementia. Although symptomatic cerebral embolisms are rare (10%, with some publications reporting SCEs in up to 30% of patients ( 5, 6). Stroke and thromboembolism are among the most harmful periprocedural complications following AF ablation procedures ( 2). However, the complexity of the procedure may expose patients to a considerable number of complications. AF catheter ablation with the goal of pulmonary vein isolation (PVI) has been established as an important therapeutic option for the treatment of AF. However, ablation technology is the only independent risk factor of SCEs and RMN can significantly reduce the incidence of SCEs resulting from AF ablation.Ĭlinical Trial Registration: ChiCTR2100046505.Ītrial fibrillation (AF) is the most common sustained cardiac arrhythmia with an increasing prevalence that affects at least 1% of the population worldwide and is associated with increased morbidity and mortality ( 1). Univariate logistic regression analysis demonstrated that ablation technology, CHA 2DS 2-VASc score, history of cerebrovascular accident/transient ischemic attack, and low ejection fraction were significantly associated with SCEs, and multivariate logistic regression analysis showed that MC ablation was the only independent risk factor of SCEs after an AF ablation procedure.Ĭonclusions: Ablation technology, CHA 2DS 2-VASc score, history of cerebrovascular accident/transient ischemic attack, and low ejection fraction are associated with SCEs. The incidences of SCEs in the RMN group and the MC group were 5.77 and 32.26%, respectively (X 2 = 20.63 P < 0.05). There were 26 total cases of SCEs in this study, including 6 cases in the RMN group and 20 cases in the MC group. The incidence and potential risk factors of SCEs were compared between the two groups. All patients underwent cerebral magnetic resonance imaging within 48 h before and after the ablation procedure to assess cerebral embolism. Patients were divided into RMN group ( n = 104) and manual control (MC) group ( n = 62), and analyzed for their demographic, medical, echocardiographic, and risk predictors of SCEs. Methods and Results: We performed a prospective study of 166 patients with paroxysmal or persistent AF who underwent pulmonary vein isolation. The purpose of this prospective study was to investigate the incidence, risk predictors and probable mechanisms of SCEs in patients with AF ablation and the potential impact of RMN on SCE rates. Background: The incidence of silent cerebral embolisms (SCEs) has been documented after pulmonary vein isolation using different ablation technologies however, it is unreported in patients undergoing with atrial fibrillation (AF) ablation using Robotic Magnetic Navigation (RMN). ![]()
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