von Bary, Christian and Deneke, Thomas and Arentz, Thomas and Schade, Anja and Lehrmann, Heiko and Schwab-Malek, Susanne and Fredersdorf, Sabine and Baldaranov, Dobri and Maier, Lars and Schlachetzki, Felix (2018) Clinical Impact of the Microembolic Signal Burden During Catheter Ablation for Atrial Fibrillation Just a Lot of Noise? JOURNAL OF ULTRASOUND IN MEDICINE, 37 (5). pp. 1091-1101. ISSN 0278-4297, 1550-9613
Full text not available from this repository. (Request a copy)Abstract
Objectives-Microembolic signal detection by transcranial Doppler ultrasonography may be considered a surrogate for cerebral events during invasive cardiac procedures. However, the impact of the microembolic signal count during pulmonary vein isolation on the clinical outcome is not well evaluated. We investigated the effect of the microembolic signal count on the occurrence of new silent cerebral embolism measured by diffusion-weighted imaging (DWI)-magnetic resonance imaging (MRI), changes in neuropsychological testing, and the occurrence of clinical events during long-term follow-up after pulmonary vein isolation. Methods-Pulmonary vein isolation was performed in 41 patients. The total microembolic signal burden (classified into "solid," "gaseous," and "equivocal") and sustained thromboembolic showers of greater than 30 seconds were recorded. Diffusion-weighted imaging-MRI and neuropsychological testing were performed before and after pulmonary vein isolation to assess for silent cerebral embolism and neuropsychological sequelae. Long-term follow-up was performed by telephone to assess for stroke/transient ischemic attack. Results-A total of 68,729 microembolic signals (14,893 solid, 11,909 gaseous, and 41,927 equivocal) with an average of 1676 signals per patient and 42 thromboembolic showers were recorded. No correlation between the microembolic signal/thromboembolic shower count and the occurrence of new DWI lesions or neuropsychological capability was found. After a mean follow-up +/- SD of 49 +/- 4 months, 1 patient had an overt transient ischemic event, which was not associated with a high microembolic signal count. Conclusions-In this multicenter study, we found no impact of the intraprocedural microembolic symbol/thromboembolic shower count on the occurrence of new DWI lesions, neuropsychological capability, or overt neurologic deficits after pulmonary vein isolation. Thus, not only the microembolic signal count but also procedural/individual factors may contribute to commensurable clinical damage, which may challenge this method as a valid biomarker during pulmonary vein isolation.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | PHASED RADIOFREQUENCY ABLATION; PULMONARY VEIN ISOLATION; TRANSCRANIAL DOPPLER DETECTION; CEREBRAL MICROEMBOLIZATION; DISCRIMINATE; PREVALENCE; PREDICTORS; EMBOLISM; SURGERY; EVENTS; ablation; atrial fibrillation; intraoperative; invasive techniques; magnetic resonance imaging; neuropsychology; transcranial Doppler (adult) |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 04 Mar 2020 13:53 |
| Last Modified: | 04 Mar 2020 13:53 |
| URI: | https://pred.uni-regensburg.de/id/eprint/14683 |
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