Vol 24, No 3 (2017)
Original articles — Interventional cardiology
Published online: 2017-03-09

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Cerebral micro-embolization during pulmonary vein isolation: Relation to post-ablation silent cerebral ischemia

Edina Nagy-Baló1, Mihran Martirosyan1, Gábor Sándorfi1, Orsolya Hajas1, Levente Lánczi2, Ervin Berényi2, Lilla Ladányi2, Alexandra Kiss1, István Édes1, Zoltán Csanádi1
Pubmed: 28281739
Cardiol J 2017;24(3):234-241.


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 intra­operative 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 mul­tivariate 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.

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