Evaluation and Reduction of Asymptomatic Cerebral Embolism in Ablation of Atrial Fibrillation, but High Prevalence of Chronic Silent Infarction: Results of the ERACE Trial

CIRCEP:  August 27, 2013

Background—This prospective, multi-center study sought to evaluate the incidence of asymptomatic cerebral embolism (ACE) during ablation of atrial fibrillation (AF) using a multi-electrode radiofrequency (MER) system when specific procedural changes were applied.

Methods and Results—Sixty subjects (age 60±10 years, 87% paroxysmal, CHADS₂ score 0.6±0.7) undergoing AF ablation with a circular MER catheter were studied. Three procedural changes were specified: (a) ablation was performed under therapeutic vitamin K antagonist (VKA) and heparin to maintain activated clotting time >350 seconds, (b) submerged loading of the catheter into the introducer prior to sheath insertion to minimize air ingress, and (c) either the distal or proximal electrode of the circular MER catheter was de-activated to prevent inadvertent bipolar radiofrequency interaction. Read more