Micro-embolus generation detected by transcranial Doppler during pulmonary vein angiography was significantly higher in patients who developed new silent cerebral ischemia post-ablation (median 257 vs 110, p=0.0009).
Observational (n=27)
Single-blind
No
Does the number of micro-embolic signals detected by transcranial Doppler during pulmonary vein isolation correlate with new silent cerebral ischemia on DW MRI in patients with atrial fibrillation?
Micro-embolus generation detected by transcranial Doppler during pulmonary vein angiography significantly correlates with new silent cerebral ischemia on DW MRI post-ablation.
Absolute Event Rate: 257% vs 110%
p-value: p=0.0009
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 intra-operative 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 mul-tivariate 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.
Nagy-Baló et al. (Fri,) conducted a observational in Atrial fibrillation (n=27). Cerebral micro-embolization during pulmonary vein angiography vs. Patients without silent cerebral ischemia was evaluated on Number of micro-embolic signals recorded during pulmonary vein angiography (p=0.0009). Micro-embolus generation detected by transcranial Doppler during pulmonary vein angiography was significantly higher in patients who developed new silent cerebral ischemia post-ablation (median 257 vs 110, p=0.0009).