title: Exchanging Catheters Over a Single Transseptal Sheath During Left Atrial Ablation is Associated with a Higher Risk for Silent Cerebral Events.
abstract: BACKGROUND
  Silent cerebral events (SCE) have been identified on magnetic resonance imaging (MRI) in asymptomatic patients after atrial fibrillation (AF) ablation. Procedural determinants influencing the risk for SCE still remain unclear.
  
  
  OBJECTIVE
  Comparing the risk for SCE depending on exchanges of catheters (ExCath) over a single transseptal sheath.
  
  
  METHODS
  88 Patients undergoing pulmonary vein isolation (PVI) only ablation using either single-tip or balloon-based technique underwent pre- and post-ablation cerebral MRI. Ablations were either performed with double transseptal access and without exchanging catheters over the transseptal sheaths (group 1: no ExCath) or after a single transseptal access and exchanges of therapeutic and diagnostic catheters (group 2: ExCath). Differences in regard to SCE rates were analyzed. Multivariate analysis was performed to identify factors related to the risk for SCE.
  
  
  RESULTS
  Included patients underwent PVI using single tip irrigated radiofrequency in 41, endoscopic laser balloon in 27 and cryoballoon in 20 cases. Overall SCE were identified in 23 (26%) patients. In group 1 (no ExCath; N=46) 6 patients (13%) and in group 2 (N=42) 17 patients (40%) had documented SCE (p=0.007). The applied ablation technology did not affect SCE rate. In multivariate analysis age (OR 1.1, p=0.03) and catheter exchanges over a single transseptal sheath (OR 12.1, p=0.007) were the only independent predictors of a higher risk for SCE.
  
  
  CONCLUSIONS
  Exchanging catheters over a single transseptal access to perform left atrial ablation is associated with a significantly higher incidence of SCE compared to an ablation technique using different transseptal accesses for therapeutic and diagnostic catheters.
authors.affiliation: Heart Center Bad Neustadt, Clinic for invasive Electrophysiology, Bad Neustadt, GER ; Ruhr-University Bochum, Bochum, GER.
authors.forename: Thomas
authors.initials: T
authors.lastname: Deneke
authors.affiliation: Heart Center Bad Neustadt, Clinic for invasive Electrophysiology, Bad Neustadt, GER.
authors.forename: Karin
authors.initials: K
authors.lastname: Nentwich
authors.affiliation: Department of Radiology, Bad Neustadt, GER.
authors.forename: Rainer
authors.initials: R
authors.lastname: Schmitt
authors.affiliation: Department of Radiology, Bad Neustadt, GER.
authors.forename: Georgios
authors.initials: G
authors.lastname: Christhopoulos
authors.affiliation: Heart Center Bad Neustadt, Clinic for invasive Electrophysiology, Bad Neustadt, GER.
authors.forename: Joachim
authors.initials: J
authors.lastname: Krug
authors.affiliation: Texas Cardiac Arrhythmia Institute at St. David`s Medical Center, Austin, USA ; Department of Biomedical Engineering, University of Texas, Austin, USA ; Department of Cardiology, University of Foggia, Foggia, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.affiliation: Texas Cardiac Arrhythmia Institute at St. David`s Medical Center, Austin, USA ; Department of Biomedical Engineering, University of Texas, Austin, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.affiliation: Heart Center Bad Neustadt, Clinic for invasive Electrophysiology, Bad Neustadt, GER.
authors.forename: Atilla
authors.initials: A
authors.lastname: Szollosi
authors.affiliation: Ruhr-University Bochum, Bochum, GER.
authors.forename: Andreas
authors.initials: A
authors.lastname: Mugge
authors.affiliation: Ruhr-University Bochum, Bochum, GER.
authors.forename: Patrick
authors.initials: P
authors.lastname: Muller
authors.affiliation: Ruhr-University Bochum, Bochum, GER.
authors.forename: Johannes W
authors.initials: JW
authors.lastname: Dietrich
authors.affiliation: Heart Center Bad Neustadt, Clinic for invasive Electrophysiology, Bad Neustadt, GER.
authors.forename: Dong-In
authors.initials: DI
authors.lastname: Shin
authors.affiliation: Heart Center Bad Neustadt, Clinic for invasive Electrophysiology, Bad Neustadt, GER.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kerber
authors.affiliation: Heart Center Bad Neustadt, Clinic for invasive Electrophysiology, Bad Neustadt, GER.
authors.forename: Anja
authors.initials: A
authors.lastname: Schade
keywords: Silent cerebral lesions; atrial fibrillation ablation; magnetic resonance imaging