Cerebral microembolization during atrial fibrillation ablation: Comparison of different single-shot ablation techniques

Abstract

Significant decreases in MES counts were observed thanks to the procedural modifications and newer RF generator with phased RF. High MES counts comparable to those with the initial phased RF resulted from the use of nMARQ.

Learning curve in circular multipolar phased radiofrequency ablation of atrial fibrillation

“…Third, although high incidence of new silent cerebral ischemia detected by diffusion-weighted magnetic resonance imaging was reported after phased RF ablations [25,26], this subclinical complication was not assessed in this study. However, most recent data indicated a very substantial reduction in silent cerebral embolization thanks to some technical and procedural modifications in phased RF ablation [27,28].…”

Cerebral micro-embolization during pulmonary vein isolation: Relation to post-ablation silent cerebral ischemia

“…The use of TCD during AF ablation was first reported by Kilicaslan et al [8], who found a significant relationship between the number of micro-embolic signals (MESs) on TCD and clinical stroke events. The present group has demonstrated that the majority of MESs are gaseous and the generation of micro-emboli is concentrated in the phase of energy delivery with some ablation techniques [9,10]. Further, the site of ablation, the ongoing rhythm and certain biophysical parameters during phased radiofrequency (RF) ablation have been found to be predictive of the rate of microembolization [11,12].…”

“…All procedures were performed on uninterrupted vitamin K antagonist therapy with a target international normalized ratio of 2.0 to 3.0, which was confirmed on the day of the ablation. The ablation protocol was reported earlier [10][11][12]. In brief, under conscious sedation, decapolar and quadripolar catheters were advanced from the femoral vein and positioned in the coronary sinus and the right ventricle.…”

Online Measurement of Microembolic Signal Burden by Transcranial Doppler during Catheter Ablation for Atrial Fibrillation—Results of a Multicenter Trial

“…More frequently, silent cerebral embolism (SCE) measured by diffusion-weighted MRI (DWI-MRI) has been shown to be a clinically unapparent thromboembolic complication following PVI (2–4). In addition, occurrence of SCE has been linked to different ablation strategies, whereby the pulmonary vein ablation catheter (PVAC) technology seemed to provoke the highest incidence of new DWI lesions (2–6). …”

“…So far, microembolus detection using transcranial Doppler (MES-TCD) has been tested in the setting of cardiac disease (i.e., AF), but it has also been used to measure the microembolic burden during invasive procedures (7, 8, 10). Recently, MES monitoring by TCD was also used as a surrogate marker for stroke risk during left atrial catheter abla-tion for AF (5, 6, 12, 13). …”