Association between Ablation Technology and Asymptomatic Cerebral Injury Following Atrial Fibrillation Ablation

Background Asymptomatic cerebral injury (ACI) detected by diffusion‐weighted magnetic resonance imaging (MRI) following atrial fibrillation (AF) ablation has been reported recently. The purpose of this study was to provide an overview of the incidence of ACI detected by MRI following AF ablation and to explore the association between ablation technology and ACI by systematically reviewing published trials. Methods and Results PubMed, Web of Science, and the Cochrane Library Databases were systematically searched for studies exploring ACI detected by MRI following AF ablation. Incidence of ACI, odds ratios, and 95% confidence intervals (CIs) were pooled. We identified 21 eligible studies. The combined ACI incidence across all studies was 15.9% (95% CI: 0.124–0.202). We also did a subgroup analysis stratified by different technologies. The incidence of ACI stratified by ablation technology was 13.0%, 27.6%, 12.5%, 17.3%, and 32.6% of the irrigated radiofrequency (RF), multielectrode‐phased RF pulmonary vein ablation catheter (PVAC), cryoballoon, laser balloon, and nMARQTM groups, respectively. Conclusions The incidence of ACI following AF ablation with PVAC was higher than with other technologies. Uninterrupted oral anticoagulant (OAC) during the procedure could lower the incidence of ACI. It seems prudent not to interrupt OACs during the procedure. In addition, intraprocedural activated clotting time was associated with ACI. Different MRI diagnostic criteria for ACI also influenced the results. To facilitate the future research, a generally accepted definition for silent cerebrovascular ischemia suitable to different kinds of MRI is needed.