Table 2.
Summary of SCI studies after different ablation techniques of PVI
| Ablation technology | Year | Study | Participants | Study design | MRI Sequences | SCIs | P-value |
|---|---|---|---|---|---|---|---|
| IRF vs PVAC vs CB | 2011 | Herrera Siklody et al75 | 74 (IRF 27; PVAC 24; CB 23) | Prospective, observational multicenter study | FLAIR, DWI | IRF 7.4% PVAC 37.5% CB 4.3% |
P=0.003 |
| IRF | 2014 | Di Biase et al76 | 428 | Patients undergoing PVI (IRF) | FLAIR, DWI | Pre-PVI 43% (prevalence) Post-PVI 7.9% (incidence) |
– |
| IRF vs PVAC vs CB | 2011 | Gaita et al77 | 108 (IRF 36; PVAC 36; CB 36) | Prospective observational | FLAIR, DWI | IRF 8.3% PVAC 38.9% CB 5.6% |
P=0.002* P=0.001** P=0.5*** |
| IRF vs CB vs LB | 2014 | Wissner et al78 | 86 (IRF 22; CB 20; LB 44) | Prospective observational | FLAIR, DWI | Pre-PVI 57% (prevalence) Post-PVI 12.8% (incidence) |
P=0.00959 |
| IRF and PVAC | 2011 | Deneke et al79 | 86 | Prospective observational | FLAIR, DWI | Post-PVI 38% (incidence) | – |
| RA-PVI vs manual IRF | 2012 | Rillig et al80 | 70 (100% AF) | Consecutive patients with AF without TIA or stroke | FLAIR, DWI | Post-PVI 17% (RA-PVI 18% vs IRF 15%) | P=ns |
| IRF | 2013 | Martinek et al81 | 131 (100% AF) | Consecutive patients with AF under continued OAC | DWI | Post-PVI 12.2% (incidence) | – |
| CB vs IRF | 2011 | Neumann et al82 | 89 (100% AF) | Single-center study | DWI | Pre-PVI 12.3% Post-PVI 7.9% (incidence) (CB 8.9% vs IRF 6.8%) |
P=ns |
| IRF vs CB vs LB | 2013 | Schmidt et al83 | 99 (100% AF) | Prospective observational | DWI | Post-PVI 22% (incidence) (IRF 24.2% vs 18.2% vs LB 24.2%) | P=ns |
| IRF | 2006 | Lickfett et al84 | 20 (100% AF) | Consecutive patients with paroxysmal AF | DWI | Post-PVI 10% (incidence) | – |
| PVAC (modified procedure) | 2013 | Wieczorek et al85 | 120 (100% AF) | Prospective observational (50% all electrodes activated vs 50% only two electrode pairs simultaneously activated) | DWI | Post-PVI 20% (incidence) (all electrodes 28.3% vs two electrodes 11.7%) | P=0.039 |
| PVAC | 2013 | Wieczorek et al85 | 37 (100% AF) | Prospective observational | DWI | Post-PVI 27% (incidence) (44% in patients with electrode interaction (E1 and E10) vs 11% in patients without) | P=0.029 |
| PVAC (three modifications) | 2013 | Verma et al86 | 60 (100% AF) | Prospective observational | FLAIR, DWI | Pre-PVI 60% with lesions Post-PVI 1.7% (incidence) |
– |
Notes:
*
P-value IRF vs PVAC.
**
P-value CB vs PVAC.
***
P-value CB vs IRF.
Abbreviations: AF, atrial fibrillation; CB, Cryoballoon; DWI, diffusion-weighted imaging; E1, electrode 1; E10, electrode 10; FLAIR, fluid-attenuated inversion recovery; IRF, irrigated radiofrequency; LB, laser balloon; MRI, magnetic resonance imaging; ns, not significant; OAC, oral anticoagulation; PVAC, pulmonary vein ablation catheter; RA-PVI, robot-assisted pulmonary vein isolation; SCI, silent cerebral infarction; vs, versus; TIA, transient ischemic attack.