Background: In EHRA2018, we reported that the overall incidence of periprocedural silent cerebral embolism (SCE) during Hot Balloon ablation for atrial fibrillation was 14.1% . In those series of the patients, the central guidewire lumen was not on closed system, i.e. whenever occlusive pulmonary venography was performed to confirm the balloon position, the syringe containing contrast medium was attached to the three-way faucet and datached for refilling it.
Method: To reduced the incidence of SCE, closed system just as the same as selective coronary angiography was introduced to avoid possible air contamination associated with syringe attach/detach maneuver. In addition, NOAC was discontinued only oh the morning of each session and resumed on the evening of the same day. In case of warfarin, it was not discontinued and no heparin bridge was utilized. During the session, heparin was administered just after the atrial septal puncture and ACT was maintained. At the end of the session, protamin was administered for removal of the sheaths. The puncture sites were closed by Z-suture and no compression was apllied.
Result: From 21 February to 12 October 2018, 100 patients were undergone Hot Balloon ablation. 78 among 100 patients were evaluated with cerebral MRI one day after each session. 11 among 78 (14.1%) were MRI-positive. No patients developted clininal neurological symptom. No thrombus or char was found on the surface menbrane of the Hot Balloon catheter.
Conclusion: The introduction of closed pulmonary venography system did not reduce the incidence of periprocedural SCE during Hot Balloon ablation for atrial fibrillation.