title: Brain Emboli After Left Ventricular Endocardial Ablation.
abstract: BACKGROUND
  Catheter ablation for ventricular tachycardia and premature ventricular complexes (PVCs) is common. Catheter ablation of atrial fibrillation is associated with a risk of cerebral emboli attributed to cardioversions and numerous ablation lesions in the low-flow left atrium, but cerebral embolic risk in ventricular ablation has not been evaluated.
  
  
  METHODS
  We enrolled 18 consecutive patients meeting study criteria scheduled for ventricular tachycardia or PVC ablation over a 9-month period. Patients undergoing left ventricular (LV) ablation were compared with a control group of those undergoing right ventricular ablation only. Patients were excluded if they had implantable cardioverter defibrillators or permanent pacemakers. Radiofrequency energy was used for ablation in all cases and heparin was administered with goal-activated clotting times of 300 to 400 seconds for all LV procedures. Pre- and postprocedural brain MRI was performed on each patient within a week of the ablation procedure. Embolic infarcts were defined as new foci of reduced diffusion and high signal intensity on fluid-attenuated inversion recovery brain MRI within a vascular distribution.
  
  
  RESULTS
  The mean age was 58 years, half of the patients were men, half had a history of hypertension, and the majority had no known vascular disease or heart failure. LV ablation was performed in 12 patients (ventricular tachycardia, n=2; PVC, n=10) and right ventricular ablation was performed exclusively in 6 patients (ventricular tachycardia, n=1; PVC, n=5). Seven patients (58%) undergoing LV ablation experienced a total of 16 cerebral emboli, in comparison with zero patients undergoing right ventricular ablation (P=0.04). Seven of 11 patients (63%) undergoing a retrograde approach to the LV developed at least 1 new brain lesion.
  
  
  CONCLUSIONS
  More than half of patients undergoing routine LV ablation procedures (predominately PVC ablations) experienced new brain emboli after the procedure. Future research is critical to understanding the long-term consequences of these lesions and to determining optimal strategies to avoid them.
authors.affiliation: From Electrophysiology Section, Division of Cardiology, University of California, San Francisco (I.R.W., R.A.G., N.B., H.H.H., B.K.L., E.P.G., G.M.M.); Department of Neurology, University of California, San Francisco (S.A.J., K.M.M., W.P.D., C.P.H.); and Division of Neuroradiology, Department of Radiology, University of California, San Francisco (W.P.D., C.P.H.).
authors.forename: Isaac R
authors.initials: IR
authors.lastname: Whitman
authors.affiliation: From Electrophysiology Section, Division of Cardiology, University of California, San Francisco (I.R.W., R.A.G., N.B., H.H.H., B.K.L., E.P.G., G.M.M.); Department of Neurology, University of California, San Francisco (S.A.J., K.M.M., W.P.D., C.P.H.); and Division of Neuroradiology, Department of Radiology, University of California, San Francisco (W.P.D., C.P.H.).
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Gladstone
authors.affiliation: From Electrophysiology Section, Division of Cardiology, University of California, San Francisco (I.R.W., R.A.G., N.B., H.H.H., B.K.L., E.P.G., G.M.M.); Department of Neurology, University of California, San Francisco (S.A.J., K.M.M., W.P.D., C.P.H.); and Division of Neuroradiology, Department of Radiology, University of California, San Francisco (W.P.D., C.P.H.).
authors.forename: Nitish
authors.initials: N
authors.lastname: Badhwar
authors.affiliation: From Electrophysiology Section, Division of Cardiology, University of California, San Francisco (I.R.W., R.A.G., N.B., H.H.H., B.K.L., E.P.G., G.M.M.); Department of Neurology, University of California, San Francisco (S.A.J., K.M.M., W.P.D., C.P.H.); and Division of Neuroradiology, Department of Radiology, University of California, San Francisco (W.P.D., C.P.H.).
authors.forename: Henry H
authors.initials: HH
authors.lastname: Hsia
authors.affiliation: From Electrophysiology Section, Division of Cardiology, University of California, San Francisco (I.R.W., R.A.G., N.B., H.H.H., B.K.L., E.P.G., G.M.M.); Department of Neurology, University of California, San Francisco (S.A.J., K.M.M., W.P.D., C.P.H.); and Division of Neuroradiology, Department of Radiology, University of California, San Francisco (W.P.D., C.P.H.).
authors.forename: Byron K
authors.initials: BK
authors.lastname: Lee
authors.affiliation: From Electrophysiology Section, Division of Cardiology, University of California, San Francisco (I.R.W., R.A.G., N.B., H.H.H., B.K.L., E.P.G., G.M.M.); Department of Neurology, University of California, San Francisco (S.A.J., K.M.M., W.P.D., C.P.H.); and Division of Neuroradiology, Department of Radiology, University of California, San Francisco (W.P.D., C.P.H.).
authors.forename: S Andrew
authors.initials: SA
authors.lastname: Josephson
authors.affiliation: From Electrophysiology Section, Division of Cardiology, University of California, San Francisco (I.R.W., R.A.G., N.B., H.H.H., B.K.L., E.P.G., G.M.M.); Department of Neurology, University of California, San Francisco (S.A.J., K.M.M., W.P.D., C.P.H.); and Division of Neuroradiology, Department of Radiology, University of California, San Francisco (W.P.D., C.P.H.).
authors.forename: Karl M
authors.initials: KM
authors.lastname: Meisel
authors.affiliation: From Electrophysiology Section, Division of Cardiology, University of California, San Francisco (I.R.W., R.A.G., N.B., H.H.H., B.K.L., E.P.G., G.M.M.); Department of Neurology, University of California, San Francisco (S.A.J., K.M.M., W.P.D., C.P.H.); and Division of Neuroradiology, Department of Radiology, University of California, San Francisco (W.P.D., C.P.H.).
authors.forename: William P
authors.initials: WP
authors.lastname: Dillon
authors.affiliation: From Electrophysiology Section, Division of Cardiology, University of California, San Francisco (I.R.W., R.A.G., N.B., H.H.H., B.K.L., E.P.G., G.M.M.); Department of Neurology, University of California, San Francisco (S.A.J., K.M.M., W.P.D., C.P.H.); and Division of Neuroradiology, Department of Radiology, University of California, San Francisco (W.P.D., C.P.H.).
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Hess
authors.affiliation: From Electrophysiology Section, Division of Cardiology, University of California, San Francisco (I.R.W., R.A.G., N.B., H.H.H., B.K.L., E.P.G., G.M.M.); Department of Neurology, University of California, San Francisco (S.A.J., K.M.M., W.P.D., C.P.H.); and Division of Neuroradiology, Department of Radiology, University of California, San Francisco (W.P.D., C.P.H.).
authors.forename: Edward P
authors.initials: EP
authors.lastname: Gerstenfeld
authors.affiliation: From Electrophysiology Section, Division of Cardiology, University of California, San Francisco (I.R.W., R.A.G., N.B., H.H.H., B.K.L., E.P.G., G.M.M.); Department of Neurology, University of California, San Francisco (S.A.J., K.M.M., W.P.D., C.P.H.); and Division of Neuroradiology, Department of Radiology, University of California, San Francisco (W.P.D., C.P.H.). marcusg@medicine.ucsf.edu.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Marcus
mesh_terms: D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging; D001921:Brain / Q000000981:diagnostic imaging; D017115:Catheter Ablation / Q000009:adverse effects*; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000601:surgery; D018879:Ventricular Premature Complexes / Q000601:surgery*
keywords: cardiac complexes, premature; catheter ablation; embolism; magnetic resonance imaging; tachycardia, ventricular