Increased number of cerebral emboli during percutaneous endocardial pulmonary vein isolation versus a thoracoscopic epicardial approach

Sauren, Loes D C; Meir, Mark La; Roy, Lucas De; Pison, Laurent; Veen, Frederik H. van der; Mess, Werner H.; Crijns, Harry J.G.M.; Maessen, Jos G.

doi:10.1016/j.ejcts.2009.05.004

Cited by 23 publications

(15 citation statements)

References 26 publications

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“…Two other studies reported on cerebral microembolization detected by TCD during different AF ablation approaches recently. 10,20 In concordance with the MRI data, the number of MESs in these studies was dependent on the ablation technology. This is the first study to our knowledge, which has also provided data regarding the composition of these microemboli by demonstrating that the majority of them are gaseous, solid particles occurring in <20% of them, regardless of the technology and the anticoagulation scheme used.…”

Section: Discussionsupporting

confidence: 70%

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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Section: Discussionsupporting

confidence: 70%

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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“…The PVI procedure can be performed with either catheter ablation or surgical ablation. Sauren and colleagues 16 investigated the occurrence of cerebral microembolic signals as a surrogate marker for the risk of neurological impairment of two different PVI methods: percutaneous endocardial RF ablation and thoracoscopic epicardial ablation using RF energy.…”

Section: Minimally Invasive Surgery For Lone Atrial Fi Brillationmentioning

confidence: 99%

Surgery for atrial fibrillation: recent progress and future perspective

Nitta

Ishii

Sakamoto

2012

Gen Thorac Cardiovasc Surg

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Development and introduction of radiofrequency ablation devices allowed the maze procedures to be performed safely and easily, further enabling off-pump pulmonary vein isolation through a mini-thoracotomy or thoracoscope. The effects of the maze procedure include prevention of stroke and other complications related to atrial fibrillation, improved cardiac performance, and relief of symptoms. Indications for the maze procedure have been discussed on the basis of the evidence. Pulmonary vein isolation has been shown to be effective in most patients with paroxysmal atrial fibrillation and can be performed with endocardial catheter ablation and minimally invasive epicardial ablation. These two modalities should be compared in terms of the success rate, occurrence of cerebral microembolic signals, capability of additional lesions indicated for persistent or long-standing persistent atrial fibrillation, and closure of the left atrial appendage. Noncontinuous or nontransmural lines of conduction block as a result of incomplete ablation can result in recurrence of atrial fibrillation and induction of atrial tachycardia. Intraoperative verification of conduction block across the ablation lines is recommended to prevent these complications. Volume reduction of the enlarged left atrium or a boxlesion to isolate the entire posterior left atrium may be effective in patients with a dilated left atrium, but the potentially impaired atrial transport function should be considered. Mapping of active ganglionated plexi and their ablation may improve the outcome of the procedure, but the long-term effect on atrial fibrillation and autonomic nerve activities should be examined.

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“…Sauren et al reported reduced incidence of cerebral microembolic signals during thoracoscopic epicardial pulmonary vein isolation compared to percutaneous endocardial ablation. 55 However, currently available strategies for epicardial ablation are significantly invasive, making them undesirable for the majority of patients. Future innovations focussed on minimally invasive percutaneous epicardial ablation are required.…”

Section: Recent Studies Remaining Challenges and Future Considerationsmentioning

confidence: 99%

Atrial Fibrillation and Stroke

DeSimone

Madhavan

Ebrille

et al. 2014

Cardiac Electrophysiology Clinics

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In this review, we focus on the important newly recognized appreciation for the paradoxical increase in stroke and TIA as a result of intervention meant to treat atrial fibrillation (AF) with the hope of decreasing stroke risk in the long term. The impact of silent cerebral lesions recently appreciated as a potentially major limitation and risk with AF ablation is explained. We categorize our present understanding of how we can minimize risk and provide a platform for what will undoubtedly be newer study, changes in the way procedures are done today, and possibly vascular-based stroke-reduction strategies.

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Increased number of cerebral emboli during percutaneous endocardial pulmonary vein isolation versus a thoracoscopic epicardial approach

Abstract: Cerebral micro-emboli during epicardial ablation are almost absent when compared to the thousands of emboli measured during percutaneous endocardial ablation.

Cited by 23 publications

References 26 publications

Transcranial Measurement of Cerebral Microembolic Signals During Pulmonary Vein Isolation

Transcranial Measurement of Cerebral Microembolic Signals During Pulmonary Vein Isolation

Surgery for atrial fibrillation: recent progress and future perspective

Atrial Fibrillation and Stroke

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