title: Increased number of cerebral emboli during percutaneous endocardial pulmonary vein isolation versus a thoracoscopic epicardial approach.
abstract: OBJECTIVE
  Pulmonary vein isolation (PVI) using ablation energy appears an effective treatment for atrial fibrillation (AF) with a success rate of approximately 80%. However, post-procedural neurological complications still occur in 0.5-10% of all patients undergoing PVI, presumably due to embolism. Therefore, we investigated the occurrence of cerebral micro-embolic signals (MES) as a surrogate marker for the risk of neurological impairment of two different PVI methods: (1) percutaneous endocardial radio-frequency (RF) ablation and (2) thoracoscopic epicardial ablation using RF energy.
  
  
  METHODS
  Ten patients (eight persistent AF and two paroxysmal AF) underwent a minimally invasive thoracoscopic epicardial (EPI) RF ablation and 10 patients (one persistent AF and nine paroxysmal AF) underwent a percutaneous endocardial (ENDO) isolation. Transcranial Doppler (TCD) was used to detect an MES in the middle cerebral arteries.
  
  
  RESULTS
  An average of 5 (+/-6) MES were detected during epicardial PVI procedure versus 3908 (+/-2816) MES during percutaneous endocardial PVI procedure. During the ablation application period, respectively, 1 (+/-1) and 2566 (+/-2296) cerebral MES were detected.
  
  
  CONCLUSIONS
  Cerebral micro-emboli during epicardial ablation are almost absent when compared to the thousands of emboli measured during percutaneous endocardial ablation.
authors: Academic Hospital Maastricht, Department of Cardiothoracic Surgery, Maastricht, The Netherlands. l.sauren@ctc.unimaas.nl
authors: Loes D
authors: LD
authors: Sauren
authors: Mark
authors: M
authors: la Meir
authors: Luc
authors: L
authors: de Roy
authors: Laurent
authors: L
authors: Pison
authors: Frederik H
authors: FH
authors: van der Veen
authors: Werner H
authors: WH
authors: Mess
authors: Harry J
authors: HJ
authors: Crijns
authors: Jos G
authors: JG
authors: Maessen
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011667:Pulmonary Veins / Q000601:surgery*; D013906:Thoracoscopy / Q000379:methods; D017585:Ultrasonography, Doppler, Transcranial