Advanced search

Transcranial measurement of cerebral microembolic signals during endocardial pulmonary vein isolation: comparison of 3 different ablation techniques

Author
Organization
Abstract
Cerebral MES During PVI. Introduction: Isolation of the pulmonary veins (PVI) using high ablation energy is an effective treatment for atrial fibrillation (AF) with a success rate of 50-95%; however, postoperative neurological complications still occur in 0.5-10%. In this study the incidence of cerebral microembolic signals (MES) as a risk factor for neurological complications is examined during 3 percutaneous endocardial ablation procedure strategies: segmental PVI using a conventional radiofrequency (RF) ablation catheter, segmental PVI using an irrigated RF tip catheter, and circumferential PVI with a cryoballoon catheter (CB). Methods and Results: Thirty patients underwent percutaneous endocardial PVI. Ostial isolation was performed in 10 patients with a conventional 4-mm RF catheter (CRF) and in 10 patients with a 4-mm irrigated RF catheter (IRF). A circumferential PVI was performed in 10 patients with a CB. Transcranial Doppler (TCD) monitoring was used to detect MES in the middle cerebral arteries. The total number of cerebral MES differs significantly among the 3 PVI groups; 3,908 cerebral MES were measured with use of the CRF catheter, 1,404 cerebral MES with use of the IRF catheter, and 935 cerebral MES with use of the CB catheter. Conclusion: This study demonstrates a significant difference in cerebral MES during PVI with 3 different ablation procedures. The use of an irrigated RF and a cryoballoon produces significantly fewer cerebral MES than the use of conventional RF for a PVI procedure, suggesting a higher risk for neurologic complications using conventional RF energy during a percutaneous PVI procedure.
Keywords
IMPACT, THROMBOGENICITY, COMPLICATIONS, BYPASS, BRAIN-INJURY, ATRIAL-FIBRILLATION, RADIOFREQUENCY CATHETER ABLATION, transcranial Doppler, stroke, atrial fibrillation, ablation, pulmonary vein isolation, cryoablation, CRYOBALLOON, THROMBUS, EFFICACY

Citation

Please use this url to cite or link to this publication:

Chicago
Sauren, Loes D, Yves Van Belle, Luc De Roy, Laurent Pison, Mark La Meir, Frederick H Van Der Veen, Harry J Crijns, Luc Jordaens, Werner H Mess, and Jos G Maessen. 2009. “Transcranial Measurement of Cerebral Microembolic Signals During Endocardial Pulmonary Vein Isolation: Comparison of 3 Different Ablation Techniques.” Journal of Cardiovascular Electrophysiology 20 (10): 1102–1107.
APA
Sauren, L. D., Van Belle, Y., De Roy, L., Pison, L., La Meir, M., Van Der Veen, F. H., Crijns, H. J., et al. (2009). Transcranial measurement of cerebral microembolic signals during endocardial pulmonary vein isolation: comparison of 3 different ablation techniques. JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 20(10), 1102–1107.
Vancouver
1.
Sauren LD, Van Belle Y, De Roy L, Pison L, La Meir M, Van Der Veen FH, et al. Transcranial measurement of cerebral microembolic signals during endocardial pulmonary vein isolation: comparison of 3 different ablation techniques. JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY. 2009;20(10):1102–7.
MLA
Sauren, Loes D et al. “Transcranial Measurement of Cerebral Microembolic Signals During Endocardial Pulmonary Vein Isolation: Comparison of 3 Different Ablation Techniques.” JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY 20.10 (2009): 1102–1107. Print.
@article{8110452,
  abstract     = {Cerebral MES During PVI.
Introduction: Isolation of the pulmonary veins (PVI) using high ablation energy is an effective treatment for atrial fibrillation (AF) with a success rate of 50-95%; however, postoperative neurological complications still occur in 0.5-10%. In this study the incidence of cerebral microembolic signals (MES) as a risk factor for neurological complications is examined during 3 percutaneous endocardial ablation procedure strategies: segmental PVI using a conventional radiofrequency (RF) ablation catheter, segmental PVI using an irrigated RF tip catheter, and circumferential PVI with a cryoballoon catheter (CB). 
Methods and Results: Thirty patients underwent percutaneous endocardial PVI. Ostial isolation was performed in 10 patients with a conventional 4-mm RF catheter (CRF) and in 10 patients with a 4-mm irrigated RF catheter (IRF). A circumferential PVI was performed in 10 patients with a CB. Transcranial Doppler (TCD) monitoring was used to detect MES in the middle cerebral arteries. 
The total number of cerebral MES differs significantly among the 3 PVI groups; 3,908 cerebral MES were measured with use of the CRF catheter, 1,404 cerebral MES with use of the IRF catheter, and 935 cerebral MES with use of the CB catheter. 
Conclusion: This study demonstrates a significant difference in cerebral MES during PVI with 3 different ablation procedures. The use of an irrigated RF and a cryoballoon produces significantly fewer cerebral MES than the use of conventional RF for a PVI procedure, suggesting a higher risk for neurologic complications using conventional RF energy during a percutaneous PVI procedure.},
  author       = {Sauren, Loes D and Van Belle, Yves and De Roy, Luc and Pison, Laurent and La Meir, Mark and Van Der Veen, Frederick H and Crijns, Harry J and Jordaens, Luc and Mess, Werner H and Maessen, Jos G},
  issn         = {1045-3873},
  journal      = {JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY},
  keywords     = {IMPACT,THROMBOGENICITY,COMPLICATIONS,BYPASS,BRAIN-INJURY,ATRIAL-FIBRILLATION,RADIOFREQUENCY CATHETER ABLATION,transcranial Doppler,stroke,atrial fibrillation,ablation,pulmonary vein isolation,cryoablation,CRYOBALLOON,THROMBUS,EFFICACY},
  language     = {eng},
  number       = {10},
  pages        = {1102--1107},
  title        = {Transcranial measurement of cerebral microembolic signals during endocardial pulmonary vein isolation: comparison of 3 different ablation techniques},
  url          = {http://dx.doi.org/10.1111/j.1540-8167.2009.01509.x},
  volume       = {20},
  year         = {2009},
}

Altmetric
View in Altmetric
Web of Science
Times cited: