title: Cerebral micro-embolization during pulmonary vein isolation: Relation to post-ablation silent cerebral ischemia.
abstract: BACKGROUND
  High incidences of silent cerebral ischemia (SCI) have been revealed by diffusion-weighted magnetic resonance imaging (DW MRI) after pulmonary vein isolation (PVI) for atrial fibrillation. A high number of mostly gaseous micro-embolic signals (MESs) was detected by transcranial Doppler (TCD) during PVI. In this investigation the possible relationship between MESs detected intraoperatively by TCD and new SCI on DW MRI post-ablation is reported.
  
  
  METHODS
  27 consecutive atrial fibrillation patients (6 female, age median: 64 interquartile range: 13.23) undergoing PVI with the pulmonary vein ablation catheter, pre- and post-ablation DW MRI and intra-operative MES detection by TCD were included in the study. Procedures were performed on a therapeutic international normalized ratio (2-3) and with a target activated clotting time ≥ 350 s in all patients. DW MRI scans performed pre- and post-ablation revealed new SCI in 6 out of 27 (22%) patients.
  
  
  RESULTS
  The median (interquartile range) MES count recorded during the whole procedure was 1642 (912) in patients with and 1019 (529) in those without SCI (p = 0.129). The number of MESs recorded during pulmonary vein angiography was significantly higher in patients as compared to those without a new lesion on the post-ablation DW MRI: 257 (249) vs. 110 (71), respectively (p = 0.0009). On mul-tivariate logistic regression, the total MES count was predictive of SCI in patients older than 68 years.
  
  
  CONCLUSIONS
  Micro-embolus generation detected by TCD during pulmonary vein angiography significantly correlates with new SCI on DW MRI post-ablation.
authors.forename: Edina
authors.initials: E
authors.lastname: Nagy-Baló
authors.forename: Mihran
authors.initials: M
authors.lastname: Martirosyan
authors.forename: Gábor
authors.initials: G
authors.lastname: Sándorfi
authors.forename: Orsolya
authors.initials: O
authors.lastname: Hajas
authors.forename: Levente
authors.initials: L
authors.lastname: Lánczi
authors.forename: Ervin
authors.initials: E
authors.lastname: Berényi
authors.forename: Lilla
authors.initials: L
authors.lastname: Ladányi
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kiss
authors.forename: István
authors.initials: I
authors.lastname: Édes
authors.affiliation: Department of Cardiology, University of Debrecen, Hungary, Hungary. drcsanadi@hotmail.com.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Csanádi
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D015994:Incidence; D020766:Intracranial Embolism / Q000150:complications* / Q000175:diagnosis; D007431:Intraoperative Complications / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D017585:Ultrasonography, Doppler, Transcranial
keywords: diffusion-weighted magnetic resonance imaging; microembolic signals; silent cerebral ischemia; transcranial Doppler