Cerebral Diffusion‐Weighted Magnetic Resonance Imaging: A Tool to Monitor the Thrombogenicity of Left Atrial Catheter Ablation

Lickfett, Lars; Hackenbroch, M. H.; Lewalter, Thorsten; Selbach, Stephanie; Schwab, Jörg O.; Yang, Alexander; Balta, Osman; Schrickel, Jan W.; Bitzen, Alexander; Lüderitz, Berndt; Sommer, Torsten

doi:10.1111/j.1540-8167.2005.00279.x

Cited by 127 publications

(96 citation statements)

References 41 publications

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“…1 This procedure, however, requires great attention to prevent both thromboembolic and hemorrhagic complications such as cerebral infarctions and cardiac tamponade. [1][2][3] Several studies have shown that the periprocedural continuation of therapeutic warfarin could reduce thromboembolic complications without increasing the risk of hemorrhagic complications. [4][5][6][7][8][9] In addition, it has been reported that cardiac tamponade as a complication of AF ablation is not difficult to manage when the procedure is performed under therapeutic international normalized ratio (INR).…”

mentioning

confidence: 99%

Efficacy and Safety of Periprocedural Dabigatran in Patients Undergoing Catheter Ablation of Atrial Fibrillation

Kaseno

Naito

Nakamura

et al. 2012

Circ J

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confidence: 99%

Efficacy and Safety of Periprocedural Dabigatran in Patients Undergoing Catheter Ablation of Atrial Fibrillation

Kaseno

Naito

Nakamura

et al. 2012

Circ J

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“…7,8 In contrast to clinically evident stroke, few data exist on the possibility of experiencing a silent cerebral embolism in the context of AF ablation. 9,10 Because of these considerations, knowledge of the incidence of silent cerebral embolism as well as clinically manifest stroke in the context of AF ablation is important. These data will enable us to fully comprehend the clinical implications of AF ablation and to better assess the risk profile of the procedure.…”

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confidence: 99%

Radiofrequency Catheter Ablation of Atrial Fibrillation: A Cause of Silent Thromboembolism?

et al. 2010

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Background-Radiofrequency left atrial catheter ablation has become a routine procedure for treatment of atrial fibrillation. The aim of this study was to assess with preprocedural and postprocedural cerebral magnetic resonance imaging the thromboembolic risk, either silent or clinically manifest, in the context of atrial fibrillation ablation. The secondary end point was the identification of clinical or procedural parameters that correlate with cerebral embolism. Methods and Results-A total of 232 consecutive patients with paroxysmal or persistent atrial fibrillation who were candidates for radiofrequency left atrial catheter ablation were included in the study. Pulmonary vein isolation or pulmonary vein isolation plus linear lesions plus atrial defragmentation with the use of irrigated-tip ablation catheters was performed. All of the patients underwent preprocedural and postablation cerebral magnetic resonance imaging. A periprocedural symptomatic cerebrovascular accident occurred in 1 patient (0.4%). Postprocedural cerebral magnetic resonance imaging was positive for new embolic lesions in 33 patients (14%). No clinical parameters such as age, hypertension, diabetes mellitus, previous history of stroke, type of atrial fibrillation, and preablation antithrombotic treatment showed significant correlation with ischemic cerebral embolism. Procedural parameters such as activated clotting time value and, in particular, electric or pharmacological cardioversion to sinus rhythm correlated with an increased incidence of cerebral embolism. Cardioversion was also associated with an increased risk of 2.75 (95% confidence interval, 1.29 to 5.89; Pϭ0.009). Conclusions-Radiofrequency left atrial catheter ablation carries a low risk of symptomatic cerebral ischemia but is associated with a substantial risk of silent cerebral ischemia detected on magnetic resonance imaging. Independent risk factors for cerebral thromboembolism are the level of activated clotting time and, in particular, the electric or pharmacological cardioversion to sinus rhythm during the procedure. (Circulation. 2010;122:1667-1673.)

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“…1 Recent data suggest, that clinically apparent cerebral ischemia is only the "tip of the iceberg" because silent ischemic lesions can be demonstrated by diffusionweighted cerebral MRI in a much higher proportion of the patients undergoing left atrial (LA) ablation. [2][3][4][5][6][7] Although the clinical relevance of these lesions is unknown, they raise new concerns regarding the safety of AF ablation. Importantly, a significant correlation has been demonstrated between the incidence of these cerebral lesions and the ablation technology used: circular multipolar phased radiofrequency (RF) ablation has consistently been associated with the highest incidence of new lesion formation, in up to 37% of the procedures, whereas cryoenergy seems to be the safest technique.…”

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confidence: 99%

Transcranial Measurement of Cerebral Microembolic Signals During Pulmonary Vein Isolation

Nagy‐Baló

Țînț

Clemens

et al. 2013

Circ: Arrhythmia and Electrophysiology

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Background-Pulmonary vein isolation has increasingly been used to cure atrial fibrillation, but concerns have recently been raised that subclinical brain damage may occur because of microembolization during these procedures. We compared the occurrence of bubble formation seen on intracardiac echocardiography and the microembolic signals (MESs) detected by transcranial Doppler on the use of different ablation techniques and anticoagulation strategies. Methods and Results-This prospective study included 35 procedures in 34 consecutive patients (age, 52; SD, 12.8 years;female:male 9:25). Pulmonary vein isolation was performed with a cryoballoon and the conventional anticoagulation protocol (activated clotting time >250 s) in 10 procedures (group 1), with a multipolar duty-cycled radiofrequency pulmonary group 2), and with regime a pulmonary vein ablation catheter with an aggressive anticoagulation (activated clotting time >320 s) in 13 procedures (group 3). The mean total numbers of MESs detected during the procedures were 833.7 (SD, 727.4) in group 1, 3142.6 (SD, 1736.4) in group 2, and 2204.6 (SD, 1078.1) in group 3 (P=0.0005). MESs were detected mostly during energy delivery in the pulmonary vein ablation catheter groups, whereas a relatively even distribution of emboli formation was seen during cryoballoon ablations. A significant correlation was found in all groups between the degree of bubble formation on intracardiac echocardiography and the number of MESs (P=0.0000). Conclusions-Duty-cycled radiofrequency ablation is associated with significantly more MESs, even when more aggressive anticoagulation is applied. With both techniques most of these microemboli are gaseous in nature.

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Cerebral Diffusion‐Weighted Magnetic Resonance Imaging: A Tool to Monitor the Thrombogenicity of Left Atrial Catheter Ablation

Cited by 127 publications

References 41 publications

Efficacy and Safety of Periprocedural Dabigatran in Patients Undergoing Catheter Ablation of Atrial Fibrillation

Efficacy and Safety of Periprocedural Dabigatran in Patients Undergoing Catheter Ablation of Atrial Fibrillation

Radiofrequency Catheter Ablation of Atrial Fibrillation: A Cause of Silent Thromboembolism?

Transcranial Measurement of Cerebral Microembolic Signals During Pulmonary Vein Isolation

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