Pulsed field ablation with a variable-loop catheter saw a high rate of ischemic cerebral lesions (ICLs) in patients with nonparoxysmal atrial fibrillation (AFib), and a majority of lesions identified were in the posterior cerebrovascular territory, according to a study published Jan. 26 in JACC: Clinical Electrophysiology.

Victor Laskov, MD, et al., enrolled 21 patients (age 66, 38% women) with nonparoxysmal AFib in their single-center study, who underwent pulmonary vein and left atrial posterior wall isolation. Brain MRI was used to detect acute ICL post procedure.

Overall, ICLs were observed in 14 (67%) patients. There was a median of two lesions per patient, and the median cumulative lesion burden was 10.5 mm. In addition, 56% of ICLs were found in the posterior territory.

The authors also note that one patient experienced a transient ischemic attack and another patient had a major peri-procedural stroke (National Institutes of Health Stroke Scale = 6; modified Rankin scale = 3 at 30-day follow up).

The study was meant to include 40 patients in total; however, the authors terminated the study early due to safety concerns. Although they attempted to enroll consecutive patients, 12 could not be included, introducing the possibility of selection bias.

"In our original study design, we planned a 12-month follow-up including MRI scans and the [Montreal Cognitive Assessment] to evaluate potential cognitive correlates of MRI-detected lesions," state the authors. "Despite early termination of the trial, we will proceed with this follow-up to provide additional insight into the potential cognitive effects of ICLs."