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von Bary, Christian ; Deneke, Thomas ; Arentz, Thomas ; Schade, Anja ; Lehrmann, Heiko ; Fredersdorf, Sabine ; Baldaranov, Dobri ; Maier, Lars ; Schlachetzki, Felix

Online measurement of microembolic signal burden by transcranial doppler during catheter ablation for atrial fibrillation - Results of a multicenter trial

von Bary, Christian, Deneke, Thomas, Arentz, Thomas, Schade, Anja, Lehrmann, Heiko, Fredersdorf, Sabine, Baldaranov, Dobri, Maier, Lars and Schlachetzki, Felix (2017) Online measurement of microembolic signal burden by transcranial doppler during catheter ablation for atrial fibrillation - Results of a multicenter trial. Frontiers in Neurology 8 (131), pp. 1-9.

Date of publication of this fulltext: 06 Apr 2017 13:54
Article
DOI to cite this document: 10.5283/epub.35530


Abstract

Introduction: Left atrial pulmonary vein isolation (PVI) is an accepted treatment option for patients with symptomatic atrial fibrillation (AF). This procedure can be complicated by stroke or silent cerebral embolism. Online measurement of microembolic signals (MESs) by transcranial Doppler (TCD) may be useful for characterizing thromboembolic burden during PVI. In this prospective multicenter ...

Introduction: Left atrial pulmonary vein isolation (PVI) is an accepted treatment option for patients with symptomatic atrial fibrillation (AF). This procedure can be complicated by stroke or silent cerebral embolism. Online measurement of microembolic signals (MESs) by transcranial Doppler (TCD) may be useful for characterizing thromboembolic burden during PVI. In this prospective multicenter trial, we investigated the burden, characteristics, and composition of MES during left atrial catheter ablation using a variety of catheter technologies. Materials and methods: PVI was performed in a total of 42 patients using the circular-shaped multielectrode pulmonary vein ablation catheter (PVAC) technology in 23, an irrigated radiofrequency (IRF) in 14, and the cryoballoon (CB) technology in 5 patients. TCD was used to detect the total MES burden and sustained thromboembolic showers (TESs) of >30 s. During TES, the site of ablation within the left atrium was registered. MES composition was classified manually into solid, gaseous, or equivocal by off-line expert assessment. Results: The total MES burden was higher when using IRF compared to CB (2,336 +/- 1,654 vs. 593 +/- 231; p = 0.007) and showed a tendency toward a higher burden when using IRF compared to PVAC (2,336 +/- 1,654 vs. 1,685 +/- 2,255; p = 0.08). TES occurred more often when using PVAC compared to IRF (1.5 +/- 2 vs. 0.4 +/- 1.3; p = 0.04) and most frequently when ablation was performed close to the left superior pulmonary vein (LSPV). Of the MES, 17.004 (23%) were characterized as definitely solid, 13.204 (18%) as clearly gaseous, and 44.366 (59%) as equivocal. Discussion: We investigated the burden and characteristics of MES during left atrial catheter ablation for AF. All ablation techniques applied in this study generated a relevant number of MES. There was a significant difference in total MES burden using IRF compared to CB and a tendency toward a higher burden using IRF compared to PVAC. The highest TES burden was found in the PVAC group, particularly during ablation close to the LSPV. The composition of thromboembolic particles was balanced. The impact of MES, TES, and composition of thromboembolic particles on neurological outcome needs to be evaluated further.



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Details

Item typeArticle
Journal or Publication TitleFrontiers in Neurology
Publisher:Frontiers
Open Access Type:Gold (with APC)
Place of Publication:LAUSANNE
Volume:8
Number of Issue or Book Chapter:131
Page Range:pp. 1-9
Date5 April 2017
InstitutionsMedicine > Lehrstuhl für Innere Medizin II
Medicine > Lehrstuhl für Neurologie
Identification Number
ValueType
10.3389/fneur.2017.00131DOI
Article-ID: 131UNSPECIFIED
KeywordsPULMONARY VEIN ISOLATION; CEREBRAL MICROEMBOLIZATION; IRRIGATED RADIOFREQUENCY; DISCRIMINATE; PREVALENCE; REDUCTION; EMBOLISM; IMPACT; ENERGY; catheter ablation; stroke; atrial fibrillation; microemboli; transcranial Doppler
Dewey Decimal Classification600 Technology > 610 Medical sciences Medicine
StatusPublished
RefereedYes, this version has been refereed
Created at the University of RegensburgYes
URN of the UB Regensburgurn:nbn:de:bvb:355-epub-355305
Item ID35530

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