Clinical Impact of the Microembolic Signal Burden During Catheter Ablation for Atrial Fibrillation: Just a Lot of Noise?

Bary, Christian von; Deneke, Thomas; Arentz, Thomas; Schade, Anja; Lehrmann, Heiko; Schwab-Malek, Susanne; Fredersdorf, Sabine; Baldaranov, Dobri; Maier, Lars S.; Schlachetzki, Felix

doi:10.1002/jum.14447

Cited by 11 publications

(8 citation statements)

References 31 publications

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“…The possible causes could be explained by the different number of MES in invasive procedures, heterogeneous methods used to analyze HITS, and by the fact that the studies differ as to the batteries of cognitive tests and testing batteries and time at which they were delivered. The impact of the intraprocedural MES counts on the occurrence of new MRI-DWI lesions, neuropsychological capability, or overt neurologic defi cits after pulmonary vein isolation was not demonstrated in a German multicentric study (28).…”

Section: Discussionmentioning

confidence: 92%

Cognitive changes associated with cerebral emboli during coronary intervention

VISZLAYOVA,

SKOLOUDIK,

BROZMAN

et al. 2023

BLL

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OBJECTIVE: To investigate factors infl uencing the frequency and type of microembolic signals (MES) detected using transcranial Doppler (TCD) in patients undergoing elective coronary intervention, and to correlate MES with silent stroke detected using magnetic resonance imaging (MRI) and cognitive dysfunction. METHODS: The subset study of a randomized clinical trial was conducted on 70 patients (58 males; mean age 59.9 ± 8.4 years) who underwent bilateral TCD monitoring of middle cerebral arteries (MCAs) during elective coronary interventions. Neurologic examination and brain MRI were performed prior to, and 24 h post-intervention. Cognitive function tests were performed prior to, and on day 30 post-intervention. RESULTS: The incidence of detected MES was 94.3 %. Eighteen (25.7 %) patients had new clinically asymptomatic ischemic lesions on MRI. The number of solid MES negatively correlated with changes in revised Addenbrooke's Cognitive Examination test (ACE-R) and, the number of solid MES and combinations of solid and gaseous MES negatively correlated with changes in Mini Mental-State Examination (MMSE)conducted on day 30 after the intervention (p < 0.05 in all cases). CONCLUSION: Cardiac catheterization was associated with a high risk of cerebral embolism in our patients. A higher number of solid MES and combinations of solid and gaseous MES was associated with the deterioration in cognitive tests (Tab.

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Section: Discussionmentioning

confidence: 92%

Cognitive changes associated with cerebral emboli during coronary intervention

VISZLAYOVA,

SKOLOUDIK,

BROZMAN

et al. 2023

BLL

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“…This study shows as well that the majority of the signals are gaseous signals [ 8 ]. Another multicentre study by a German research group confirms the mass occurrence of embolic, predominantly gaseous signals during atrial fibrillation ablation [ 9 ]. In the current work, the embolic signals were counted during the following prespecified procedural steps: transseptal puncture, catheter flushing, catheter exchange via transseptal sheath, angiography of the pulmonary veins, electroanatomical mapping, irrigated RF ablation and finally during admission of protamine.…”

Section: Discussionmentioning

confidence: 99%

Simple periprocedural precautions to reduce Doppler microembolic signals during AF ablation

Christoph

Poitz

Pfluecke

et al. 2021

J Interv Card Electrophysiol

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Background Doppler microembolic signals (MES) occur during atrial fibrillation ablation despite of permanent flushed transseptal sheaths, frequent controls of periprocedural coagulation status and the use of irrigated ablation catheters Purpose To investigate the number and type of MES depending on the procedure time, prespecified procedure steps, the activated clotting time (ACT) during the ablation procedure and the catheter contact force. Methods In a prospective trial, 53 consecutive atrial fibrillation patients underwent pulmonary vein isolation by super-irrigated “point-by-point” ablation. All patients underwent a periinterventional, continuous transcranial Doppler examination (TCD) of the bilateral middle cerebral arteries during the complete ablation procedure. Results An average of 686±226 microembolic signals were detected by permanent transcranial Doppler. Thereby, 569±208 signals were differentiated as gaseous and 117±31 as solid MES. The number of MES with regard to defined procedure steps were as follows: gaseous: [transseptal puncture, 26 ± 28; sheath flushing, 24±12; catheter change, 21±11; angiography, 101±28; mapping, 9±9; ablation, 439±192; protamine administration, 0±0]; solid: [transseptal puncture, 8±8; sheath flushing, 9±5; catheter replacement, 6±6; angiography, not measurable; mapping, 2±5; ablation, 41±22; protamine administration, 0±0]. Significantly less MES occurred with shorter procedure time, higher ACT and the use of tissue contact force monitoring. Conclusion The current study demonstrates that during atrial fibrillation ablation using irrigated, “point-by-point” RF ablation, masses of microembolic signals are detected in transcranial ultrasound especially in the period of RF current application. The number of MES depends on the total procedure time and the reached ACT during ablation. The use of contact force monitoring might reduce MES during RF ablation.

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“…57,58 The clinical relevance of asymptomatic cerebral embolism detected on MRI and transcranial Doppler remains, however, unclear. 59,60 Despite technical improvements, the second-generation PVAC-Gold catheter still showed a high incidence of asymptomatic cerebral embolism (20 % versus none, p=0.011) and a higher amount and duration of microembolic signals compared with irrigated RFCA in a randomised clinical trial from our centre. 58…”

Section: Procedures Timementioning

confidence: 91%

The Impact of Advances in Atrial Fibrillation Ablation Devices on the Incidence and Prevention of Complications

Keçe

Zeppenfeld

Trines

2018

Arrhythmia &Amp; Electrophysiology Review

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The number of patients with atrial fibrillation currently referred for catheter ablation is increasing. However, the number of trained operators and the capacity of many electrophysiology labs are limited. Accordingly, a steeper learning curve and technical advances for efficient and safe ablation are desirable. During the last decades several catheter-based ablation devices have been developed and adapted to improve not only lesion durability, but also safety profiles, to shorten procedure time and to reduce radiation exposure. The goal of this review is to summarise the reported incidence of complications, considering device-related specific aspects for point-bypoint, multi-electrode and balloon-based devices for pulmonary vein isolation. Recent technical and procedural developments aimed at reducing procedural risks and complications rates will be reviewed. In addition, the impact of technical advances on procedural outcome, procedural length and radiation exposure will be discussed.

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Clinical Impact of the Microembolic Signal Burden During Catheter Ablation for Atrial Fibrillation: Just a Lot of Noise?

Cited by 11 publications

References 31 publications

Cognitive changes associated with cerebral emboli during coronary intervention

Cognitive changes associated with cerebral emboli during coronary intervention

Simple periprocedural precautions to reduce Doppler microembolic signals during AF ablation

The Impact of Advances in Atrial Fibrillation Ablation Devices on the Incidence and Prevention of Complications

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