title: Cerebral diffusion-weighted magnetic resonance imaging: a tool to monitor the thrombogenicity of left atrial catheter ablation.
abstract: BACKGROUND
  Cerebral embolism and stroke are feared complications of left atrial catheter ablation such as pulmonary vein (PV) ablation. In order to assess the thrombogenicity of left atrial catheter ablation, knowledge of both clinically evident as well as silent cerebral embolism is important. The aim of the current study was to examine the use of diffusion-weighted magnetic resonance imaging (DW-MRI) for detection of cerebral embolism, apparent as well as silent, caused by PV catheter ablation.
  
  
  RESULTS
  Twenty consecutive patients without structural heart disease undergoing lasso catheter-guided ostial PV ablation using an irrigated-tip ablation catheter were studied. Cerebral MRI including DW single-shot spin echo echoplanar, turbo fluid attenuated inversion recovery, and T2-weighted turbo spin echo sequences were performed the day after the ablation procedure. Ten patients also underwent preprocedure cerebral MRI. All ablation procedures were performed without acute complications. A mean of 3.2 +/- 0.6 PVs were ablated per patient. No patient had neurological symptoms following the procedure. In 2 of 20 patients (10%), DW-MRI revealed new embolic lesions, which were located in the right periventricular white matter in one and in the left temporal lobe in the other patient. There was no statistically significant difference in age, history of hypertension, left atrial volume, and procedure duration between the 2 patients with and the 18 patients without cerebral embolism following AF ablation.
  
  
  CONCLUSIONS
  This is the first study using highly sensitive DW-MRI of the brain to detect asymptomatic cerebral embolism after left atrial catheter ablation. Even small, clinically silent, embolic lesions can be demonstrated with this technique. DW-MRI can be used to monitor and compare the thrombogenicity of different AF ablation approaches.
authors.affiliation: Department of Medicine-Cardiology, University of Bonn, Bonn, Germany. lars.lickfett@ukb.uni-bonn.de
authors.forename: Lars
authors.initials: L
authors.lastname: Lickfett
authors.forename: Matthias
authors.initials: M
authors.lastname: Hackenbroch
authors.forename: Thorsten
authors.initials: T
authors.lastname: Lewalter
authors.forename: Stephanie
authors.initials: S
authors.lastname: Selbach
authors.forename: Jörg O
authors.initials: JO
authors.lastname: Schwab
authors.forename: Alexander
authors.initials: A
authors.lastname: Yang
authors.forename: Osman
authors.initials: O
authors.lastname: Balta
authors.forename: Jan
authors.initials: J
authors.lastname: Schrickel
authors.forename: Alexander
authors.initials: A
authors.lastname: Bitzen
authors.forename: Berndt
authors.initials: B
authors.lastname: Lüderitz
authors.forename: Torsten
authors.initials: T
authors.lastname: Sommer
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000601:surgery*; D001921:Brain / Q000473:pathology*; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006325:Heart Atria / Q000601:surgery*; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis* / Q000209:etiology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011667:Pulmonary Veins / Q000601:surgery; D012680:Sensitivity and Specificity; D016896:Treatment Outcome