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. 2020 Apr 25;16(6):1288-1294.
doi: 10.5114/aoms.2020.94747. eCollection 2020.

Cerebral microembolism during atrial fibrillation ablation can result from the technical aspects and mostly does not cause permanent neurological deficit

Anetta Lasek-Bal  1 , Przemysław Puz  1 , Joanna Wieczorek  2 , Seweryn Nowak  2 , Anna Maria Wnuk-Wojnar  2 , Aldona Warsz-Wianecka  1 , Katarzyna Mizia-Stec  2
Affiliations

Cerebral microembolism during atrial fibrillation ablation can result from the technical aspects and mostly does not cause permanent neurological deficit

Anetta Lasek-Bal et al. Arch Med Sci. .

Abstract

Introduction: Atrial fibrillation ablation can be associated with microembolism detected in the intracranial arteries and risk of neurological incidents. The aims of this study were to evaluate microembolic signals (MES) during pulmonary vein isolation (PVI) and establish the potential significance of MES for damage of the brain in radiological investigation and neurological state.

Material and methods: In the prospective study we included patients with atrial fibrillation undergoing percutaneous pulmonary vein isolation (radiofrequency ablation/balloon cryoablation) with ultrasound monitoring of microembolisms in the middle cerebral artery. Neurological examination and MRI of the head were performed in all participants.

Results: The study enrolled 80 patients at a mean age of 58 years. Microembolisms during the monitoring of the flow in the right middle cerebral artery were recorded in 61 (76.3%) patients in the amount of 51-489 (mean: 239). Most often the microembolic signals were registered during the trans-septal puncture and the stage of ablation. In 89%, microembolisms were gaseous. Mean score on the Fazekas scale for the whole group before ablation: 0.87 ±0.7 (0-3, med. 1); after: 0.93 ±0.71. In 3 (4.3%) patients the lesions worsened during the follow-up period. None of the patients revealed a cardiovascular event during the follow-up period and no changes were observed in the neurological status.

Conclusions: The majority of cerebral microembolisms generated during PVI are gaseous in nature. The cerebral microembolisms associated with PVI probably result from the technical aspects of the procedure and do not cause either permanent brain damage in the radiological investigation or neurological deficit.

Keywords: ablation; atrial fibrillation; microembolic signals; microembolism; pulmonary vein isolation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Distribution of microembolic signals (MES) over individual stages of the procedure
Figure 2
Figure 2
Vascular lesions in the Fazakas scale 1 grade
Figure 3
Figure 3
Vascular lesions in the Fazekas scale 3 stage
See this image and copyright information in PMC

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