Main findings
embolic lesions, cognitive decline
Among published studies comparing the HPSD technique with the conventional approach, this is the first RCT using the incidence of periprocedural SCE as the primary outcome. The main findings are summarized as follows. (1) Despite detecting lesions using brain hDWI at a thickness of 1 mm, no significant differences were found in the incidence, average lesion number, maximum lesion diameter, and total lesion volume of SCE between patients in the HPSD group using the novel STSF catheter and the conventional group using the ST catheter. (2) Persistent AF and CHACerebral embolic lesions, reported up to 67.3% [However, the results of recently published SHORT-AF study [Up to 42 enrolled patients (42%) had SCE in the present study. Although catheter ablation without anticoagulant interruption is recommended at a class I level [As previously discussed, patient-related characteristics of persistent AF and CHAIn the present study, 106 lesions in 42 patients were identified by hDWI after ablation, but none of the patients exhibited clinical symptoms. Meanwhile, no significant cognitive decline was detected in SCE patients by the MoCA test during the 3-month follow-up. Of the 106 lesions identified, 53 (50%) were small (< 3 mm), 52 (49%) were medium (3 mm ≤ diameter < 10 mm), and only one (1%) was large (≥ 10 mm). In a study conducted by Dr. Deneke et al. [