Innovative Approaches to Assess the Impact and Steps to Decrease the Neurological Consequences of Ablation

Abstract

ABSTRACT. Despite continued innovations in catheter design and technique, catheter ablation for atrial fibrillation (AF) is still fraught with a few serious complications-most feared of which is stroke. Although a ''classic'' clinically disabling stroke is less common (about 1%) after AF ablation, many recent studies have identified an increased incidence of asymptomatic ischemic cerebral lesions known as ''silent clinical lesions'' (SCLs) associated with the procedure. As once thought, these new SCLs seen on post-ablation magnetic resonance imaging of the brain were not actually clinically ''silent'' and were shown to have significant clinical and neuropsychiatric effects on these patients in the long term. These SCLs are thought to represent the ''embolic fingerprints'' of the ablation procedure, suggesting involvement and the need for innovation as well as improved safety at multiple levels before, during, and after the procedure. This may require a multimodality approach involving several measures such as having better peri-procedural anticoagulation strategies, using real-time monitoring for markers of neurologic injury, giving meticulous attention to sheath management, using novel energy sources that are less thrombogenic, and finally establishing imaging protocols for timely detection of these lesions post ablation. The current literature is reviewed here to explore such opportunities to improve neurological outcomes of catheter ablation for AF.

Efficacy of Anti-Thrombogenic Coating in Decreasing the Rate of Clot Formation on Indwelling Intravascular Devices during Intra-Cardiac Ablation

“…Thromboembolism poses a serious risk to patients undergoing catheter ablation [1]. In addition to risk of overt stroke and myocardial infarction, what were once thought to be "asymptomatic" brain lesions detected on magnetic resonance imaging (MRI) are now shown to be associated with long term risk of dementia and cognitive decline [2][3][4]. In fact, these brain lesions are quite common and, depending on ablation modality used and MRI definition, they can be present in up to a third of patients undergoing pulmonary vein isolation for atrial fibrillation [2][3][4][5][6].…”