Objectives: It is known that silent microembolic events occur in up to nearly 50% of all patients with pulmonary vein isolation, depending on the ablation technology and strategy used. The Impact of neurocpsychological function of these embolic events is still unclear. Moreover, there are no data about microembolic burden and neuropsychologigal outcome in patients receiving extrapulmonary ablation using Cryoballon technique.     

Methods: 100 consecutive Patients with paroxysmal (Group A: PAF, N=50) and persistent AF (Group B, PERS-AF, N=50), who had a bone acoustic window for microembolic detection (MED) by transcranial Doppler ultrasonography and met further predefined inclusion criteria were eligible for participation in this prospective observational study. Group A received Cryo-PVI only, Group B Cryo-PVI and additional roofline. MED was continuously recorded during all EP procedures. All patients underwent three times (day before, day after and 3 month in Follow up) extensive neuropsychological examination using the CERAD-Plus battery, which consists of 11 neuropsychological tests.  

Results: Of 167 screened patients, 100 scheduled were included: Groups A/B [median (IQR)]: Age: 66 (57-71) / 65 (58-72) p=0.564, CHA₂DS₂VASc: 2 (1-3) / 2 (1-4) p=0.056, LA Index: 31,7 ml/m² (24 – 38.9) / 48.07 (38.5-56.1) p<0.001, LVEF: 60% (60-65) / 55% (50-60) p<0.001,  male/female: 56/44% vs. 82/18 p=0.005, stroke in history 4% / 6% p=0.140. Neuropsychological outcome is summarized for the entire group in Table 1.

Conclusion:

In a comprehensive neuropsychological assessement our study indicate, patients abilities remain unaffected by the procedure of cryoballoon PVI only and beyond.