Background: The incidence of silent cerebral embolisms (SCEs) has been documented after pulmonary vein isolation using different ablation technologies; however, it is unreported in patients undergoing with atrial fibrillation (AF) ablation using Robotic Magnetic Navigation (RMN). The purpose of this prospective study was to investigate the incidence, risk predictors and probable mechanisms of SCEs in patients with AF ablation and the potential impact of RMN on SCE rates.

Methods and Results: We performed a prospective study of 166 patients with paroxysmal or persistent AF who underwent pulmonary vein isolation. Patients were divided into RMN group (n = 104) and manual control (MC) group (n = 62), and analyzed for their demographic, medical, echocardiographic, and risk predictors of SCEs. All patients underwent cerebral magnetic resonance imaging within 48 h before and after the ablation procedure to assess cerebral embolism. The incidence and potential risk factors of SCEs were compared between the two groups. There were 26 total cases of SCEs in this study, including 6 cases in the RMN group and 20 cases in the MC group. The incidences of SCEs in the RMN group and the MC group were 5.77 and 32.26%, respectively (X² = 20.63 P < 0.05). Univariate logistic regression analysis demonstrated that ablation technology, CHA₂DS₂-VASc score, history of cerebrovascular accident/transient ischemic attack, and low ejection fraction were significantly associated with SCEs, and multivariate logistic regression analysis showed that MC ablation was the only independent risk factor of SCEs after an AF ablation procedure.

Conclusions: Ablation technology, CHA₂DS₂-VASc score, history of cerebrovascular accident/transient ischemic attack, and low ejection fraction are associated with SCEs. However, ablation technology is the only independent risk factor of SCEs and RMN can significantly reduce the incidence of SCEs resulting from AF ablation.

Clinical Trial Registration: ChiCTR2100046505.

背景：使用不同消融技术隔离肺静脉后，已记录了无症状脑栓塞 (SCE) 的发生率；然而，在使用机器人磁导航 (RMN) 进行心房颤动 (AF) 消融的患者中没有报道。本前瞻性研究的目的是调查房颤消融患者 SCE 的发生率、风险预测因素和可能的机制，以及 RMN 对 SCE 率的潜在影响。

方法和结果：我们对 166 名接受肺静脉隔离的阵发性或持续性 AF 患者进行了前瞻性研究。患者分为RMN组（n = 104) 和手动控制 (MC) 组 (n= 62)，并分析了他们的人口统计学、医学、超声心动图和 SCE 风险预测因素。所有患者在消融手术前后 48 小时内接受脑磁共振成像以评估脑栓塞。比较两组SCEs的发生率及潜在危险因素。本次研究共发生SCEs 26例，其中RMN组6例，MC组20例。RMN 组和 MC 组 SCE 的发生率分别为 5.77% 和 32.26%（X ² = 20.63磷< 0.05)。单因素Logistic回归分析显示消融技术、CHA ₂ DS ₂ -VASc评分、脑血管意外/短暂性脑缺血发作史、低射血分数与SCEs显着相关，多变量Logistic回归分析显示MC消融是唯一的独立风险AF 消融手术后 SCE 的因素。

结论：消融技术、CHA ₂ DS ₂ -VASc 评分、脑血管意外/短暂性脑缺血发作史和低射血分数与 SCE 相关。但消融技术是 SCEs 的唯一独立危险因素，RMN 可显着降低 AF 消融所致 SCEs 的发生率。

临床试验注册： ChiCTR2100046505。