Influence of cardioversion on asymptomatic cerebral lesions following atrial fibrillation ablation

Liu, Guijian; Chen, Ruizhen; Zhu, Wenqing; Cheng, Ke-Di; Xu, Ye; Chen, Qingxing; Ge, Junbo

doi:10.1007/s10840-014-9904-0

Cited by 2 publications

(1 citation statement)

References 28 publications

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“…A number of studies have shown that intraprocedural electrical cardioversion is an independent predictor of SCLs. 25 , 29 , 42 Mechanistically, this might relate to the dislodgement of thrombotic material from equipment—or from fresh ablation lesions—due to the sudden movement caused by direct current cardioversion or by restoration of atrial contraction.…”

Section: Introductionmentioning

confidence: 99%

Silent cerebral lesions following catheter ablation for atrial fibrillation: a state-of-the-art review

et al. 2023

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Atrial fibrillation is associated with neurocognitive comorbidities such as stroke and dementia. Evidence suggests that rhythm control—especially if implemented early—may reduce the risk of cognitive decline. Catheter ablation is highly efficacious for restoring sinus rhythm in the setting of atrial fibrillation; however, ablation within the left atrium has been shown to result in MRI-detected silent cerebral lesions. In this state-of-the-art review article, we discuss the balance of risk between left atrial ablation and rhythm control. We highlight suggestions to lower the risk, as well as the evidence behind newer forms of ablation such as very high power short duration radiofrequency ablation and pulsed field ablation.

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Section: Introductionmentioning

confidence: 99%

Silent cerebral lesions following catheter ablation for atrial fibrillation: a state-of-the-art review

et al. 2023

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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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Influence of cardioversion on asymptomatic cerebral lesions following atrial fibrillation ablation

Abstract: Cardioversion during AF ablation significantly increased the risk of asymptomatic cerebral lesions on MRI following the procedure. Additional studies are required to further verify the association.

Cited by 2 publications

References 28 publications

Silent cerebral lesions following catheter ablation for atrial fibrillation: a state-of-the-art review

Silent cerebral lesions following catheter ablation for atrial fibrillation: a state-of-the-art review

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

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