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Influence of Clinical Parameters and Anticoagulation on Intraprocedural Cerebral Microembolic Signals during

Robert Larbig1, Ralf Dittrich2, Simon Kochhaeuser1

  • 1Division of Electrophysiology, Department of Cardiovascular Medicine, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.

Plos One
|June 22, 2016
PubMed
Abstract

Insights

Pre-ablation oral anticoagulation (OAC) and higher INR values correlate with fewer cerebral microembolic signals (MES) during pulmonary vein isolation (PVI) for atrial fibrillation (AF). This suggests OAC may be beneficial even for low-risk patients undergoing PVI.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Devices

Background:

  • Pulmonary vein isolation (PVI) for atrial fibrillation (AF) carries risks of thromboembolism and stroke.
  • Cerebral microembolic signals (MES) can quantify embolic burden during procedures.
  • The influence of clinical factors on embolic risk during PVI remains unclear.

Purpose of the Study:

  • To investigate the impact of clinical parameters and anticoagulation status on MES during PVI.
  • To assess whether patient characteristics predict embolic burden in AF patients undergoing PVI.

Main Methods:

  • Retrospective analysis of 118 AF patients undergoing PVI.
  • Evaluation of clinical parameters (CHADS2, CHA2DS2-VASc scores), pulmonary vein variants, and echocardiographic data.
  • Comparison of MES rates across three ablation approaches: radiofrequency ablation (iRF), pulmonary vein ablation catheter (PVAC) with deactivated electrode pair (PVAC-red), and PVAC without deactivation (PVAC-all).

Main Results:

  • The PVAC-all approach was associated with significantly higher MES rates compared to iRF and PVAC-red (p<0.001).
  • Patients on pre-ablation oral anticoagulation (OAC) exhibited lower MES counts (p=0.005).
  • Higher INR values correlated with lower MES counts (p=0.029).

Conclusions:

  • Clinical predictors of stroke do not directly correlate with cerebral embolic burden during PVI.
  • Pre-ablation OAC and adequate INR levels are associated with reduced MES during PVI.
  • Consideration of pre-ablation anticoagulation, even in low-risk AF patients, may be beneficial to minimize embolic events during PVI.

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