Influence of Clinical Parameters and Anticoagulation on Intraprocedural Cerebral Microembolic Signals during Pulmonary Vein Isolation.
OBJECTIVE
We had the objective to determine the impact of clinical parameters and anticoagulation status on cerebral microembolic signals (MES) during pulmonary vein isolation (PVI) for atrial fibrillation (AF).


BACKGROUND
Thromboembolism and stroke are the most feared complications of PVI. MES can help to evaluate embolic burden. It is unknown whether clinical parameters have an impact on embolic risk during PVI.


METHODS
In this retrospective analysis we investigated the impact of clinical parameters, including the CHADS2- and CHA2DS2-VASc-score, pulmonary vein variants and echocardiographic parameters on MES rates in patients that underwent PVI using three different ablation approaches (radiofrequency ablation (iRF), pulmonary vein ablation catheter (PVAC) with deactivated electrode pair 1 or 5 (PVAC-red) or PVAC without deactivation (PVAC-all).


RESULTS
118 AF patients (61±12 years) were included between 2011 and 2013 (Median: 489 MES during PVI). Patients were more likely to have more MES (within 4th quartile) with the PVAC-all approach (60.7% vs. 25.0% (iRF) vs. 14.3% (PVAC-red) respectively (p<0.001). Patients with oral anticoagulation (OAC) pre-ablation were more likely to have lower MES-counts (1st-3rd quartile); (65.6% vs. 35.7%; p = 0.005). Additionally, patients with lower MES counts (1st-3rd quartile) had significantly higher INR values than those in the 4th quartile (1.78 vs. 1.09; p = 0.029). 2 patients developed a potentially thromboembolic event during the procedure.


CONCLUSIONS
Clinical predictors of cerebral emboli and stroke do not correlate with cerebral embolic burden during PVI. Pre-ablation OAC and increased INR values correlate with decreased MES-rates. Therefore, it might be beneficial to perform PVI with pre-ablation anticoagulation even in low risk patients.
Division of Electrophysiology, Department of Cardiovascular Medicine, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
Robert
R
Larbig
Department of Neurology, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
Ralf
R
Dittrich
Division of Electrophysiology, Department of Cardiovascular Medicine, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
Simon
S
Kochhaeuser
Division of Electrophysiology, Department of Cardiovascular Medicine, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
Patrick
P
Leitz
Division of Electrophysiology, Department of Cardiovascular Medicine, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
Fatih
F
Guener
Department of Neurology, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
Catharina
C
Korsukewitz
Division of Electrophysiology, Department of Cardiovascular Medicine, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
Dirk
D
Dechering
Division of Electrophysiology, Department of Cardiovascular Medicine, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
Christian
C
Pott
Division of Electrophysiology, Department of Cardiovascular Medicine, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
Kristina
K
Wasmer
Helios Klinikum Krefeld, Department of Urology, Lutherplatz 40, 47805, Krefeld, Germany.
Jan
J
Schmitges
Division of Electrophysiology, Department of Cardiovascular Medicine, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
Monika
M
Kerckhoff
Division of Electrophysiology, Department of Cardiovascular Medicine, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
Lars
L
Eckardt
Division of Electrophysiology, Department of Cardiovascular Medicine, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
Gerold
G
Moennig
D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D020766:Intracranial Embolism / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011667:Pulmonary Veins / Q000601:surgery*
D000925:Anticoagulants