Key result
Thoracoscopic epicardial ablation resulted in almost absent cerebral micro-embolic signals (average 5) compared to percutaneous endocardial ablation (average 3908).
Why the study?
Does thoracoscopic epicardial RF ablation reduce the occurrence of cerebral micro-embolic signals compared to percutaneous endocardial RF ablation in patients with atrial fibrillation?
Cohort (n=20)
Does thoracoscopic epicardial RF ablation reduce the occurrence of cerebral micro-embolic signals compared to percutaneous endocardial RF ablation in patients with atrial fibrillation?
Absolute Event Rate: 5% vs 3908%
Thoracoscopic epicardial ablation is associated with almost no cerebral micro-emboli compared to thousands of emboli during percutaneous endocardial ablation, suggesting a potentially lower risk of neurological complications.
May indicate lower embolic risk with thoracoscopic epicardial ablation in AF; leaves open impact on clinical events pending randomized confirmation.
OBJECTIVE: Pulmonary vein isolation (PVI) using ablation energy appears an effective treatment for atrial fibrillation (AF) with a success rate of approximately 80%. However, post-procedural neurological complications still occur in 0.5-10% of all patients undergoing PVI, presumably due to embolism. Therefore, we investigated the occurrence of cerebral micro-embolic signals (MES) as a surrogate marker for the risk of neurological impairment of two different PVI methods: (1) percutaneous endocardial radio-frequency (RF) ablation and (2) thoracoscopic epicardial ablation using RF energy. METHODS: Ten patients (eight persistent AF and two paroxysmal AF) underwent a minimally invasive thoracoscopic epicardial (EPI) RF ablation and 10 patients (one persistent AF and nine paroxysmal AF) underwent a percutaneous endocardial (ENDO) isolation. Transcranial Doppler (TCD) was used to detect an MES in the middle cerebral arteries. RESULTS: An average of 5 (+/-6) MES were detected during epicardial PVI procedure versus 3908 (+/-2816) MES during percutaneous endocardial PVI procedure. During the ablation application period, respectively, 1 (+/-1) and 2566 (+/-2296) cerebral MES were detected. CONCLUSIONS: Cerebral micro-emboli during epicardial ablation are almost absent when compared to the thousands of emboli measured during percutaneous endocardial ablation.
No takes yet. Share an insight, caveat, or question.
Sauren et al. (2009) conducted a cohort in Atrial fibrillation (n=20). Thoracoscopic epicardial radio-frequency ablation vs. Percutaneous endocardial radio-frequency ablation was evaluated on Cerebral micro-embolic signals (MES) detected by Transcranial Doppler. Thoracoscopic epicardial ablation resulted in almost absent cerebral micro-embolic signals (average 5) compared to percutaneous endocardial ablation (average 3908).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: