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

Nagy‐Baló, Edina; Martirosyan, Mihran; Sándorfi, Gábor; Hajas, Orsolya; Lánczi, Levente; Berényi, Ervin; Ladányi, Lilla; Kiss, Alexandra; Édes, István; Csanádi, Zoltán

doi:10.5603/cj.a2017.0030

Cited by 5 publications

(6 citation statements)

References 22 publications

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“…Although not every MES implies cerebral infarction, they have been linked to hyperintense signals on DW-MRI and have been shown to be a predictor of clinical embolic events and stroke. 29,30 TCD monitoring provides a unique opportunity to determine the number and characteristics of MESs present during the different phases of the procedure. 4,28,30,31 This suggests that NSE may be used to detect cerebral injury after ablation, but further evaluation is needed to clarify whether there is a correlation with MRI-detected SCE.…”

Section: Diagnosis and Detection Of Scementioning

confidence: 99%

“…29,30 TCD monitoring provides a unique opportunity to determine the number and characteristics of MESs present during the different phases of the procedure. 4,28,30,31 This suggests that NSE may be used to detect cerebral injury after ablation, but further evaluation is needed to clarify whether there is a correlation with MRI-detected SCE.…”

Section: Diagnosis and Detection Of Scementioning

confidence: 99%

“…Furthermore, studies with series postprocedural MRI scans had shown that most acute SCE lesions were no longer visible during follow-up. 4,30,52,84,88 The neurological effects of these lesions are unclear and may be determined by their size, number, and distribution. Although the impact of SCEs on immediate and long-term cognitive function is still a controversial topic, given that most AF patients are elderly and AF itself increases the risk of cognitive impairment, SCEs should not be overlooked.…”

Section: The Impact Of Sce On Cognitionmentioning

confidence: 99%

“…Transcranial Doppler (TCD) sonography offers real‐time detection of blood flow velocities and microembolic signals (MES) within the middle cerebral artery. Although not every MES implies cerebral infarction, they have been linked to hyperintense signals on DW‐MRI and have been shown to be a predictor of clinical embolic events and stroke 29,30 . TCD monitoring provides a unique opportunity to determine the number and characteristics of MESs present during the different phases of the procedure 4,28,30,31 .…”

Section: Introductionmentioning

confidence: 99%

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Atrial fibrillation catheter ablation associated silent cerebral emboli: A narrative review

Zhang

Sang

et al. 2023

Pacing Clinical Electrophis

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The incidence of silent cerebral emboli (SCE) associated with atrial fibrillation catheter ablation (AFCA) is much higher than that of stroke/transient ischemic attack (TIA). Interventional electrophysiologists have been increasingly alerted to asymptomatic cerebral infarction over the years. Plentiful studies revealed that diagnostic definitions, detection modalities, energy sources, ablation strategies, perioperative anticoagulation regimens, and patient‐related factors were associated with the risk of AFCA‐associated SCE. Studies related to non‐interventional procedures found that SCE may prompt stroke, cognitive decline, and dementia later in life, suggesting a possible role of AFCA‐associated SCE in the cognitive function of patients with AF. However, there is no consistent evidence for this view to date. Given that the majority of patients with AF being elderly and the increased risk of cognitive impairment in AF itself, efforts should be made to minimize the occurrence of AFCA‐associated SCE.

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Section: Diagnosis and Detection Of Scementioning

confidence: 99%

Section: Diagnosis and Detection Of Scementioning

confidence: 99%

Section: The Impact Of Sce On Cognitionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Atrial fibrillation catheter ablation associated silent cerebral emboli: A narrative review

Zhang

Sang

et al. 2023

Pacing Clinical Electrophis

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“…Because patients with AF exist in a pre-thromboembolic state, many studies have confirmed that determining the plasma D-dimer level, combined with clinical risk factors, can effectively predict thromboembolic events in NVAF patients [Sadanaga 2010;Erdogan 2014;El Borgi 2015;Kim 2016]. However, a single micro-embolic signal does not necessarily lead to the clinical symptoms of a cerebral embolism [Nagy-Baló 2017].…”

Section: Introductionmentioning

confidence: 99%

Roles of Microembolus and Plasma D-dimer in Evaluating the Warfarin Anticoagulant Therapy Efficacies for Patients with Atrial Fibrillation

Wang

Jiang

et al. 2019

HSF

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Background: To investigate the roles of microembolus and plasma D-dimer in evaluating the warfarin anticoagulant therapy efficacies for patients with atrial fibrillation (AF). Methods: Fifty-six AF patients were treated with aspirin antiplatelet therapy (Group ASP) and forty AF patients were treated with warfarin anticoagulant therapy (Group WAR). The microemboli and plasma D-dimer in these two groups were monitored and compared before and after treatment. Results: Group ASP had 21 and 17 cases with positive microemboli before and after treatment, respectively, and there was no significant difference in the detection rate of microemboli before and after treatment; Group WAR had 14 and 5 cases with positive microemboli before and after treatment, respectively, and the detection rate of microemboli was significantly reduced after treatment. The levels of plasma D-dimer in the two groups were significantly reduced after treatment (327±73 µg/L vs 235±61 µg/L and 313±81 µg/L vs 170±67 µg/L, respectively, P<0.05), among which the reduction level in Group WAR was more significant. Conclusions: Microemboli and D-dimer can be used as the indicators for evaluating the embolism risk and therapeutic efficacies in AF patients.

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Incidence and Clinical Significance of Cerebral Embolism During Atrial Fibrillation Ablation With Duty-Cycled Phased-Radiofrequency Versus Cooled-Radiofrequency

Keçe

Bruggemans

Riva

et al. 2019

JACC: Clinical Electrophysiology

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

Abstract: Background: High incidences of silent cerebral ischemia (SCI) have been revealed by diffusion-weight- DW MRI post-ablation. (Cardiol J 2017; 24, 3: 234-241)

Cited by 5 publications

References 22 publications

Atrial fibrillation catheter ablation associated silent cerebral emboli: A narrative review

Atrial fibrillation catheter ablation associated silent cerebral emboli: A narrative review

Roles of Microembolus and Plasma D-dimer in Evaluating the Warfarin Anticoagulant Therapy Efficacies for Patients with Atrial Fibrillation

Incidence and Clinical Significance of Cerebral Embolism During Atrial Fibrillation Ablation With Duty-Cycled Phased-Radiofrequency Versus Cooled-Radiofrequency

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