eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
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6/2020
vol. 16
 
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Electrophysiology
abstract:
Clinical research

Cerebral microembolism during atrial fibrillation ablation can result from the technical aspects and mostly does not cause permanent neurological deficit

Anetta Lasek-Bal
1
,
Przemysław Puz
1
,
Joanna Wieczorek
2
,
Seweryn Nowak
2
,
Anna Maria Wnuk-Wojnar
2
,
Aldona Warsz-Wianecka
1
,
Katarzyna Mizia-Stec
2

1.
Department of Neurology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
2.
First Department of Cardiology, School of Medicine, Medical University of Silesia, Katowice, Poland
Arch Med Sci 2020; 16 (6): 1288–1294
Online publish date: 2020/04/25
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Introduction
Atrial fibrillation ablation can be associated with microembolism detected in the intracranial arteries and risk of neurological incidents. The aims of this study were to evaluate microembolic signals (MES) during pulmonary vein isolation (PVI) and establish the potential significance of MES for damage of the brain in radiological investigation and neurological state.

Material and methods
In the prospective study we included patients with atrial fibrillation undergoing percutaneous pulmonary vein isolation (radiofrequency ablation/balloon cryoablation) with ultrasound monitoring of microembolisms in the middle cerebral artery. Neurological examination and MRI of the head were performed in all participants.

Results
The study enrolled 80 patients at a mean age of 58 years. Microembolisms during the monitoring of the flow in the right middle cerebral artery were recorded in 61 (76.3%) patients in the amount of 51–489 (mean: 239). Most often the microembolic signals were registered during the trans-septal puncture and the stage of ablation. In 89%, microembolisms were gaseous. Mean score on the Fazekas scale for the whole group before ablation: 0.87 ±0.7 (0–3, med. 1); after: 0.93 ±0.71. In 3 (4.3%) patients the lesions worsened during the follow-up period. None of the patients revealed a cardiovascular event during the follow-up period and no changes were observed in the neurological status.

Conclusions
The majority of cerebral microembolisms generated during PVI are gaseous in nature. The cerebral microembolisms associated with PVI probably result from the technical aspects of the procedure and do not cause either permanent brain damage in the radiological investigation or neurological deficit.

keywords:

ablation, pulmonary vein isolation, microembolism, microembolic signals, atrial fibrillation

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