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Predictors of Cerebral Microembolization during Phased Radiofrequency Ablation of Atrial Fibrillation: Role of the Ongoing Rhythm and the Site of Energy Delivery
Author(s) -
NAGYBALO EDINA,
KISS ALEXANDRA,
CONDIE CATHERINE,
STEWART MARK,
EDES ISTVAN,
CSANADI ZOLTAN
Publication year - 2014
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12454
Subject(s) - medicine , pulmonary vein , ablation , atrial fibrillation , sinus rhythm , cardiology , catheter ablation , transcranial doppler , magnetic resonance imaging , radiology
Background Pulmonary vein isolation with phased radiofrequency current and use of a pulmonary vein ablation catheter (PVAC) has recently been associated with a high incidence of clinically silent brain infarcts on diffusion‐weighted magnetic resonance imaging, and a high microembolic signal (MES) count detected by transcranial Doppler. We investigated the potential effects of the ongoing rhythm and the target vein during energy delivery (ED) on MES generation during PVAC ablations. Methods and Results A total of 735 EDs during 48 PVAC ablations were analyzed. MES counts were recorded for each ED and time‐stamped for correlation with the ongoing rhythm and the target vein for each ED. Significantly higher MES counts were observed during ablations of the left‐sided as compared with the right‐sided pulmonary veins (P = 0.0003). Similarly, higher MES counts were detected during EDs in atrial fibrillation as compared with sinus rhythm when the temperature was >56°C (P < 0.0001). The ongoing rhythm had no effect on the number of MESs at lower temperatures during ablation. Conclusions Both the ongoing rhythm during ED and the site of ablation influence microembolus generation during PVAC ablation procedures.