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Clinical Trial
. 2010 Jan;12(1):52-7.
doi: 10.1093/europace/eup350.

Incidence and predictors of silent cerebral embolism during pulmonary vein catheter ablation for atrial fibrillation

Jan Wilko Schrickel  1 , Lars Lickfett, Thorsten Lewalter, Erica Mittman-Braun, Stephanie Selbach, Katharina Strach, Claas P Nähle, Jörg Otto Schwab, Markus Linhart, Rene Andrié, Georg Nickenig, Torsten Sommer
Affiliations
Clinical Trial

Incidence and predictors of silent cerebral embolism during pulmonary vein catheter ablation for atrial fibrillation

Jan Wilko Schrickel et al. Europace. 2010 Jan.

Abstract

Aims: Left atrial catheter ablation of the pulmonary veins (PV) has evolved as an important therapeutic option for the treatment of atrial fibrillation (AF). We aimed to investigate the incidence and predictors of silent cerebral embolism associated with PV catheter ablation, detected by diffusion-weighted magnetic resonance imaging (DW-MRI).

Methods and results: We performed a prospective analysis of 53 consecutive patients with persistent or paroxysmal AF that underwent PV ablation and post-procedural cerebral MRI 1 day after lasso catheter-guided ostial PV ablation. Patients were analysed for possible demographical, medical, echocardiographical, and procedural predictors of embolic events. A mean of 3.5 +/- 0.5 PVs were ablated per patient. In six patients, DW-MRI depicted new clinically silent microembolism after PV ablation (11%). The number of ineffective medical antiarrhythmic agents prior to ablation procedure was significantly higher in the embolism group (3.3 +/- 0.5 vs. 2.2 +/- 1.4, P = 0.014). Coronary heart disease (CAD) was more frequent in patients with cerebral embolisms (33 vs. 2%, P = 0.031); left ventricular volume (130 +/- 12 vs. 103 +/- 26 mL, P = 0.002), and septal wall thickness (13.0 +/- 1.4 vs. 7.9 +/- 4.8 mm, P = 0.025) were significantly increased.

Conclusion: This study shows a high incidence of silent micro-embolic events after PV ablation. CAD, left ventricular dilatation, and hypertrophy were potential predictors of this complication.

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