Microembolizations in the Arterial Cerebral Circulation in Patients with Atrial Fibrillation Ablation Using the Cryoballoon Technique—Protocol and Methodology of a Prospective Observational Study

Erkapic, Damir; Aleksic, M.; Roussopoulos, Konstantinos; Weipert, Kay; Sözener, Korkut; Kostev, Karel; Allendörfer, Jens; Rosenbauer, Josef; Guenduez, Dursun; Tanislav, Christian

doi:10.3390/diagnostics13091660

Cited by 3 publications

(1 citation statement)

References 45 publications

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“…Furthermore, in a study examining the connection between epicardial fat distribution and left heart size [ 8 ], Nattel S [ 9 ] emphasized the influence of cardiac anatomy on AF, contributing to a deeper understanding of its pathogenesis. Earlier research has revealed associations between AF and climatic factors, such as air pollution [ 10 , 11 , 12 ] and temperature [ 13 ]. In a large Danish population-based study, Murphy N F et al [ 14 ] observed a significant seasonal correlation between temperature and the incidence of AF, particularly a higher occurrence during colder seasons [ 15 ], in hospitalized patients with acute ischemic stroke.…”

Section: Introductionmentioning

confidence: 99%

A Novel Approach to Dual Feature Selection of Atrial Fibrillation Based on HC-MFS

Liu,

Lu,

Xiong

et al. 2024

Diagnostics

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This investigation sought to discern the risk factors for atrial fibrillation within Shanghai’s Chongming District, analyzing data from 678 patients treated at a tertiary hospital in Chongming District, Shanghai, from 2020 to 2023, collecting information on season, C-reactive protein, hypertension, platelets, and other relevant indicators. The researchers introduced a novel dual feature-selection methodology, combining hierarchical clustering with Fisher scores (HC-MFS), to benchmark against four established methods. Through the training of five classification models on a designated dataset, the most effective model was chosen for method performance evaluation, with validation confirmed by test set scores. Impressively, the HC-MFS approach achieved the highest accuracy and the lowest root mean square error in the classification model, at 0.9118 and 0.2970, respectively. This provides a higher performance compared to existing methods, thanks to the combination and interaction of the two methods, which improves the quality of the feature subset. The research identified seasonal changes that were strongly associated with atrial fibrillation (pr = 0.31, FS = 0.11, and DCFS = 0.33, ranked first in terms of correlation); LDL cholesterol, total cholesterol, C-reactive protein, and platelet count, which are associated with inflammatory response and coronary heart disease, also indirectly contribute to atrial fibrillation and are risk factors for AF. Conclusively, this study advocates that machine-learning models can significantly aid clinicians in diagnosing individuals predisposed to atrial fibrillation, which shows a strong correlation with both pathological and climatic elements, especially seasonal variations, in the Chongming District.

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Section: Introductionmentioning

confidence: 99%

A Novel Approach to Dual Feature Selection of Atrial Fibrillation Based on HC-MFS

Liu,

Lu,

Xiong

et al. 2024

Diagnostics

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Microembolizations in the arterial cerebral circulation during atrial fibrillation ablation: cryoballoon technique advantages and neurocognitive safety—results of a prospective observational study

Erkapic,

Roussopoulos,

Aleksic

et al. 2024

Europace

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Background and Aims The significance of micro-embolic signals (MES) during atrial fibrillation (AF) ablation is unclear. Previous studies had limitations, and cryoballoon (CB) ablation patients were underrepresented. Minimizing MES is recommended due to their uncertain neurocognitive impact. Methods This prospective observational study included AF patients from a German center between February 2021 and August 2022. Patients were equally divided into paroxysmal (Group A) and persistent (Group B) AF. Group A received CB-PVI only, while Group B also had left atrial roof ablation. MES were detected using transcranial Doppler ultrasonography during ablation. Neurocognitive status was assessed pre- and post-procedure and at 3 months using the CERAD Plus battery. Results The study analyzed 100 patients with a median age of 65.5 years. A total of 19,698 MES were observed, with 80% being gaseous and 20% solid in origin, primarily occurring during pulmonary vein angiography and the balloon freeze and thawing phase. The median MES per patient was 130 (IQR 92–256) in total, 298 (IQR 177-413) in bilateral (36%), and 110 (IQR 71-130) in unilateral (64%) recordings. No significant difference in total MES counts was found between the groups. None of the eleven neuropsychological tests showed cognitive decline post-procedure or at 3 months. Conclusion Our observations confirm that neurocognitive abilities are not affected either 24 hours or 3 months after AF ablation using the CB technique. However, despite the low MES burden associated with the CB, more work is needed to reduce small embolic events during AF ablation.

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Cryoballoon-Assisted Pulmonary Vein Isolation and Left Atrial Roof Ablation Using a Simplified Sedation Strategy without Esophageal Temperature Monitoring: No Notable Thermal Esophageal Lesions and Low Arrhythmia Recurrence Rates after 2 Years

Erkapic,

Roussopoulos,

Aleksic

et al. 2024

Diagnostics

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Background: Atrial fibrillation (AF) ablation is increasingly effective for managing heart rhythm but poses risks like esophageal fistulas. Minimizing esophageal thermal lesions while simplifying procedures is crucial. Methods: This prospective study involved 100 consecutive AF patients undergoing cryoballoon ablation with simplified sedation, without esophageal temperature monitoring. Patients with paroxysmal AF (Group A) received pulmonary vein isolation only, while those with persistent AF (Group B) also had left atrial roof ablation. Gastroesophageal endoscopy was performed post-procedure to detect lesions, and cardiological follow-ups were conducted at 3, 12, and 24 months. Results: The cohort included 69% men, with a median age of 65.5 years. Post-ablation endoscopy was performed in 92 patients; esophageal lesions were found in 1.1% of Group A and none of Group B. GERD was diagnosed in 14% of patients, evenly distributed between groups and not linked to lesion occurrence. Gastric hypomotility was observed in 16% of patients, with no significant difference between groups. At 24 months, arrhythmia-free survival was 88% in Group A and 74% in Group B. Conclusion: Cryoballoon-assisted pulmonary vein isolation, with or without additional left atrial roof ablation and without esophageal temperature monitoring during a simplified sedation strategy, shows low risk of esophageal thermal injury and effective ablation outcomes.

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Microembolizations in the Arterial Cerebral Circulation in Patients with Atrial Fibrillation Ablation Using the Cryoballoon Technique—Protocol and Methodology of a Prospective Observational Study

Cited by 3 publications

References 45 publications

A Novel Approach to Dual Feature Selection of Atrial Fibrillation Based on HC-MFS

A Novel Approach to Dual Feature Selection of Atrial Fibrillation Based on HC-MFS

Microembolizations in the arterial cerebral circulation during atrial fibrillation ablation: cryoballoon technique advantages and neurocognitive safety—results of a prospective observational study

Cryoballoon-Assisted Pulmonary Vein Isolation and Left Atrial Roof Ablation Using a Simplified Sedation Strategy without Esophageal Temperature Monitoring: No Notable Thermal Esophageal Lesions and Low Arrhythmia Recurrence Rates after 2 Years

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