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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 und 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), S. 1-9.

Veröffentlichungsdatum dieses Volltextes: 06 Apr 2017 13:54
Artikel
DOI zum Zitieren dieses Dokuments: 10.5283/epub.35530


Zusammenfassung

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

DokumentenartArtikel
Titel eines Journals oder einer ZeitschriftFrontiers in Neurology
Verlag:Frontiers
Ort der Veröffentlichung:LAUSANNE
Band:8
Nummer des Zeitschriftenheftes oder des Kapitels:131
Seitenbereich:S. 1-9
Datum5 April 2017
InstitutionenMedizin > Lehrstuhl für Innere Medizin II
Medizin > Lehrstuhl für Neurologie
Identifikationsnummer
WertTyp
10.3389/fneur.2017.00131DOI
Article-ID: 131Nicht ausgewählt
Stichwörter / KeywordsPULMONARY VEIN ISOLATION; CEREBRAL MICROEMBOLIZATION; IRRIGATED RADIOFREQUENCY; DISCRIMINATE; PREVALENCE; REDUCTION; EMBOLISM; IMPACT; ENERGY; catheter ablation; stroke; atrial fibrillation; microemboli; transcranial Doppler
Dewey-Dezimal-Klassifikation600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin
StatusVeröffentlicht
BegutachtetJa, diese Version wurde begutachtet
An der Universität Regensburg entstandenJa
URN der UB Regensburgurn:nbn:de:bvb:355-epub-355305
Dokumenten-ID35530

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