Microembolism and Catheter Ablation I

Haines, David E.; Stewart, Mark T.; Ahlberg, Sarah E.; Barka, Noah; Condie, Cathy; Fiedler, Gary R.; Kirchhof, Nicole; Halimi, Franck; Deneke, Thomas

doi:10.1161/circep.111.973453

Cited by 91 publications

(38 citation statements)

References 24 publications

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“…These changes were derived from preclinical investigations into embolic load creation. 9 Protocol-defined subject evaluations were conducted preprocedure, immediately postprocedure, and 1 month postprocedure. All visits included a medical history, physical examination with neurological assessment, and protocol-specified cerebral MRI evaluations as detailed below.…”

Section: Methodsmentioning

confidence: 99%

“…7,8 Subsequent animal studies showed that both gaseous and solid emboli were generated during both irrigated and MER ablation in the swine LA. 9 Specifically with the circular MER catheter, increased gas emboli were observed during catheter insertion into transseptal sheaths while both embolic and gaseous © 2013 American Heart Association, Inc. Original Article…”

Section: Editorial See P 827 Clinical Perspective On P 842mentioning

confidence: 99%

“…Pre-existing lesions were predominantly found in the frontal and parietal lobes, as demonstrated in this sample patient. There were a median of 8 lesions per subject (interquartile range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. spontaneous; 45% were electrical).…”

Section: Procedural Parametersmentioning

confidence: 99%

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Evaluation and Reduction of Asymptomatic Cerebral Embolism in Ablation of Atrial Fibrillation, But High Prevalence of Chronic Silent Infarction

Debruyne¹,

Nardi²,

Deneke³

et al. 2013

Circ: Arrhythmia and Electrophysiology

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122

104

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P ulmonary vein (PV) isolation is an effective therapy to alleviate symptoms and restore sinus rhythm in patients with atrial fibrillation (AF).1 However, recent reports have shown that ablation in the left atrium (LA) is associated with new asymptomatic cerebral emboli (ACE) visible on postprocedural diffusion-weighted cerebral MRI.2 The largest such study reported an ACE incidence of 14.2% using openirrigation radiofrequency (RF) catheters.3 Although no patient parameters were correlated with ACE, procedural parameters, such as cardioversion and activated clotting time (ACT) level, were associated with new silent lesions. Smaller subsequent reports with rates ranging from 7% to 12% have similarly implicated procedural factors to increasing ACE incidence, including concomitant diagnostic coronary angiography, 4 total RF duration, 5 and non-PV ablation.6 Editorial see p 827 Clinical Perspective on p 842Two nonrandomized studies found that use of multielectrode RF (MER) ablation was associated with elevated ACE incidence compared with irrigated RF and cryoablation, with a rate as high as 38%. 7,8 Subsequent animal studies showed that both gaseous and solid emboli were generated during both irrigated and MER ablation in the swine LA. 9 Specifically with the circular MER catheter, increased gas emboli were observed during catheter insertion into transseptal sheaths while both embolic and gaseous © 2013 American Heart Association, Inc. Original Article Circ Arrhythm ElectrophysiolBackground-This prospective, multicenter study sought to evaluate the incidence of asymptomatic cerebral emboli (ACE) during ablation of atrial fibrillation (AF) using a multielectrode radiofrequency (MER) system when specific procedural changes were applied. Methods and Results-Sixty subjects (age 60±10 years; 87% paroxysmal; CHADS 2 score, 0.6±0.7) undergoing AF ablation with a circular MER catheter were studied. Three procedural changes were specified: (1) ablation was performed under therapeutic vitamin K antagonist and heparin to maintain activated clotting time >350 seconds; (2) submerged loading of the catheter into the introducer before sheath insertion to minimize air ingress; and (3) either the distal or proximal electrode of the circular MER catheter was deactivated to prevent inadvertent bipolar radiofrequency interaction. MRI was performed <7 days preablation and 2 days postablation. Subjects with new cerebral findings after ablation underwent repeat MRI after 1 month. An acute ACE lesion was defined by a new hyperintensity on diffusion-weighted and fluidattenuated inversion recovery cerebral MRI sequences. Neurological function was evaluated at baseline, postablation, and 1 month. All target pulmonary veins were isolated. In 60% (36/60) of patients, pre-existing cerebral lesions were seen on the preprocedure MRI (8 lesions per subject; interquartile range, 3-22). New postprocedural ACE occurred in only 1/60 patients (incidence, 1.7%; 95% confidence interval, 0.04-8.9), which was no longer visible on MRI after 1 month. Conclusi...

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Section: Methodsmentioning

confidence: 99%

Section: Editorial See P 827 Clinical Perspective On P 842mentioning

confidence: 99%

See 1 more Smart Citation

Evaluation and Reduction of Asymptomatic Cerebral Embolism in Ablation of Atrial Fibrillation, But High Prevalence of Chronic Silent Infarction

Debruyne¹,

Nardi²,

Deneke³

et al. 2013

Circ: Arrhythmia and Electrophysiology

Self Cite

122

104

View full text Add to dashboard Cite

show abstract

“…7 In 2013, the effects of embolizing pure gas microbubbles and small microparticles (coagulated blood) were studied in a series of animal studies. 8,9 The pathogenesis of ACE was elucidated and attributed to microbubbles and microembolic particle debris. 8,9 Microemboli was clearly associated with acute ischemic lesions detected by diffusion-weighted magnetic resonance imaging.…”

Section: See Article By Takami Et Almentioning

confidence: 99%

Mitigating the Risk of Microemboli Formation During Irrigated Radiofrequency Catheter Ablation

Mercader

2016

Circ: Arrhythmia and Electrophysiology

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“…Помимо симптоматических церебральных событий, КА также несет в себе риск бессимптомной церебральной эмболии. С учетом результатов выполненной церебральной магнитно-резонансной томографии, частота "немых" ишеми-ческих инсультов, по данным ряда исследований, варьирует от 4% до 35% [34,35]. При развитии таких осложнений возможна связь с нейрокогнитивными нарушениями.…”

Section: варфаринunclassified

Possibility of Novel Oral Anticoagulants Usage During Ablation in Atrial Fibrillation

Татарский¹,

Баталов²,

Попов³

2014

Russ J Cardiol

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Microembolism and Catheter Ablation I

Cited by 91 publications

References 24 publications

Evaluation and Reduction of Asymptomatic Cerebral Embolism in Ablation of Atrial Fibrillation, But High Prevalence of Chronic Silent Infarction

Evaluation and Reduction of Asymptomatic Cerebral Embolism in Ablation of Atrial Fibrillation, But High Prevalence of Chronic Silent Infarction

Mitigating the Risk of Microemboli Formation During Irrigated Radiofrequency Catheter Ablation

Possibility of Novel Oral Anticoagulants Usage During Ablation in Atrial Fibrillation

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