title: Neuropsychological impact of cerebral microemboli in ablation of atrial fibrillation.
abstract: BACKGROUND
  Clinically silent lesions on cerebral magnet resonance imaging have been found in larger numbers after pulmonary vein isolation (PVI) especially with phased radio frequency (pRF) using all ten electrodes. However, the neuropsychological effects of cerebral microembolism during the procedure remain unclear and data regarding this issue so far are inconsistent.
  
  
  METHODS
  Between August 2011 and June 2012, 76 patients undergoing their first PVI were randomized to ablation with either phased (40) or irrigated (36) radio frequency (iRF). A comprehensive neuropsychological test battery was performed the day before and after PVI as well as 6 months after ablation. The occurrence of cerebral microemboli during the procedure was performed via a transcranial Doppler ultrasound device.
  
  
  RESULTS
  PVI using pRF was associated with increased number of microembolic signals (MES) compared to iRF (1530.0 ± 979.8 vs. 645.7 ± 448.7; p < 0.001). Neuropsychological assessment did not reveal any changes in correlation with the used ablation technique. Besides an age-related effect there was a diffuse, sub-clinical impairment of neurologic function depending on age and the number of MES.
  
  
  CONCLUSIONS
  There was no clinical overt cognitive deficit and no significant difference in cognitive function correlating with the used ablation technique. The number of MES correlated with a subtle, diffuse post-procedural impairment of neuropsychological function highlighting the need to reduce microemboli during ablation.
authors.affiliation: Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany, simon.kochhaeuser@ukmuenster.de.
authors.forename: S
authors.initials: S
authors.lastname: Kochhäuser
authors.forename: H H
authors.initials: HH
authors.lastname: Lohmann
authors.forename: M A
authors.initials: MA
authors.lastname: Ritter
authors.forename: P
authors.initials: P
authors.lastname: Leitz
authors.forename: F
authors.initials: F
authors.lastname: Güner
authors.forename: S
authors.initials: S
authors.lastname: Zellerhoff
authors.forename: C
authors.initials: C
authors.lastname: Korsukewitz
authors.forename: D G
authors.initials: DG
authors.lastname: Dechering
authors.forename: J
authors.initials: J
authors.lastname: Banken
authors.forename: N M
authors.initials: NM
authors.lastname: Peters
authors.forename: L
authors.initials: L
authors.lastname: Eckardt
authors.forename: G
authors.initials: G
authors.lastname: Mönnig
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D005260:Female; D005858:Germany; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D007507:Therapeutic Irrigation / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial