Incidence and predictors of silent cerebral embolism during pulmonary vein catheter ablation for atrial fibrillation.
OBJECTIVE
Left atrial catheter ablation of the pulmonary veins (PV) has evolved as an important therapeutic option for the treatment of atrial fibrillation (AF). We aimed to investigate the incidence and predictors of silent cerebral embolism associated with PV catheter ablation, detected by diffusion-weighted magnetic resonance imaging (DW-MRI).


RESULTS
We performed a prospective analysis of 53 consecutive patients with persistent or paroxysmal AF that underwent PV ablation and post-procedural cerebral MRI 1 day after lasso catheter-guided ostial PV ablation. Patients were analysed for possible demographical, medical, echocardiographical, and procedural predictors of embolic events. A mean of 3.5 +/- 0.5 PVs were ablated per patient. In six patients, DW-MRI depicted new clinically silent microembolism after PV ablation (11%). The number of ineffective medical antiarrhythmic agents prior to ablation procedure was significantly higher in the embolism group (3.3 +/- 0.5 vs. 2.2 +/- 1.4, P = 0.014). Coronary heart disease (CAD) was more frequent in patients with cerebral embolisms (33 vs. 2%, P = 0.031); left ventricular volume (130 +/- 12 vs. 103 +/- 26 mL, P = 0.002), and septal wall thickness (13.0 +/- 1.4 vs. 7.9 +/- 4.8 mm, P = 0.025) were significantly increased.


CONCLUSIONS
This study shows a high incidence of silent micro-embolic events after PV ablation. CAD, left ventricular dilatation, and hypertrophy were potential predictors of this complication.
Schrickel
Jan Wilko
JW
Department of Medicine-Cardiology, University of Bonn, Sigmund Freud Strasse 25, Bonn 53105, Germany. jan.schrickel@ukb.uni-bonn.de
Lickfett
Lars
L
Lewalter
Thorsten
T
Mittman-Braun
Erica
E
Selbach
Stephanie
S
Strach
Katharina
K
Nähle
Claas P
CP
Schwab
Jörg Otto
JO
Linhart
Markus
M
Andrié
Rene
R
Nickenig
Georg
G
Sommer
Torsten
T
D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000453:epidemiology*; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors