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Cerebral microembolism during atrial fibrillation ablation can result from the technical aspects and mostly does not
Anetta Lasek-Bal1, Przemysław Puz1, Joanna Wieczorek2
1Department of Neurology, School of Health Sciences, Medical University of Silesia, Katowice, Poland.
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.
Insights
Atrial fibrillation ablation generates microembolisms, primarily gaseous, during pulmonary vein isolation (PVI). These microembolisms do not appear to cause significant brain damage or neurological deficits.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Atrial fibrillation (AF) ablation procedures carry a risk of neurological complications due to potential microembolism.
- Evaluating microembolic signals (MES) during AF ablation is crucial for understanding neurological risks.
Purpose of the Study:
- To assess microembolic signals (MES) during pulmonary vein isolation (PVI).
- To determine the significance of MES for radiological brain damage and neurological status post-PVI.
Main Methods:
- Prospective study of 80 patients undergoing percutaneous PVI for AF.
- Ultrasound monitoring of microembolisms in the middle cerebral artery.
- Neurological examination and MRI of the head before and after ablation.
Main Results:
- Microembolisms detected in 76.3% of patients during PVI (mean 239 signals).
- Most MES occurred during trans-septal puncture and ablation; 89% were gaseous.
- No significant changes in Fazekas scale scores or neurological status observed post-ablation.
Conclusions:
- The majority of cerebral microembolisms during PVI are gaseous and likely procedural in origin.
- Cerebral microembolisms associated with PVI do not appear to cause permanent brain damage or neurological deficits.
