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Published on: August 25, 2022
Comparison of Cerebral Micro-Embolization Detected by Transcranial Doppler Examination Between Radiofrequency
Tobias Schreiber1, Regina von Rennenberg2,3,4, Tim Bastian Brämswig2,3,5,6
1Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Deutschland.
Background And Aims:
Pulsed Field Ablation (PFA) can establish pulmonary vein isolation via irreversible electroporation and is believed to reduce overall complications; however, periprocedural stroke has also been reported after PFA procedures. Assessment of microembolic signals (MES) measured by transcranial doppler (TCD) allows to monitor cerebral embolization during the procedure and to identify higher risk procedural steps. This study was designed to compare the incidence of MES during different procedural steps between two different PFA systems and radiofrequency ablation (RFA).
Methods And Results:
Pulmonary vein isolation was performed either using either high-power short-duration radiofrequency ablation (HPSD RFA), or PFA using a variable loop circular catheter (VLCC) or a circular multielectrode array catheter (CMAC). MES were compared during transseptal puncture, ablation, left atrial mapping, and introduction/retraction of catheters. Neurological examination was performed pre and post ablation for all patients including the National Institutes of Health Stroke Scale (NIHSS). Fifty-six consecutive patients (19 female (34%), average age 70 years) were included: 28 in the HPSD RFA group and 14 patients each in the VLCC and CMAC groups. Total MES count was higher for both PFA systems compared to HPSD RFA (VLCC 1402 (IQR 973), CMAC 449 (IQR 193) vs. HPSD RFA 131 (IQR 250); p < 0.001). MES count was higher in VLCC than in CMAC (p < 0.001). In all groups, MES were most frequently detected during ablation (87% of overall MES). Postprocedural NIHSS did not differ between groups (median NIHSS 0 [IQR 0] in all groups), yet two patients experienced new focal neurological deficits after PFA.
Conclusion:
Pulsed field ablation was associated with a higher cerebral MES count than high-power short-duration radiofrequency ablation, with marked differences between catheter systems. Transcranial doppler indicates ablation as the most embolic step in both PFA and high-power short duration ablation.
Insights
Pulsed Field Ablation (PFA) generated more microembolic signals (MES) than radiofrequency ablation (RFA). Transcranial doppler monitoring revealed ablation as the riskiest step for cerebral embolization during these cardiac procedures.
Area of Science:
- Cardiology
- Medical Devices
- Neurology
Background:
- Pulsed Field Ablation (PFA) is a novel technique for pulmonary vein isolation, aiming to reduce complications compared to traditional methods.
- Despite its potential benefits, periprocedural stroke has been observed following PFA procedures.
- Monitoring microembolic signals (MES) using transcranial doppler (TCD) aids in assessing cerebral embolization during cardiac ablation.
Purpose of the Study:
- To compare the incidence of MES during different procedural steps between two PFA systems and radiofrequency ablation (RFA).
- To identify procedural steps associated with higher risk of cerebral embolization.
Main Methods:
- Pulmonary vein isolation was performed using high-power short-duration RFA (HPSD RFA), PFA with a variable loop circular catheter (VLCC), or PFA with a circular multielectrode array catheter (CMAC).
- MES were quantified using TCD during transseptal puncture, ablation, left atrial mapping, and catheter manipulation.
- Neurological examinations, including the NIH Stroke Scale (NIHSS), were conducted pre- and post-procedure.
Main Results:
- A total of 56 patients were included (28 HPSD RFA, 14 VLCC PFA, 14 CMAC PFA).
- Both PFA systems showed significantly higher total MES counts compared to HPSD RFA (VLCC: 1402, CMAC: 449 vs. RFA: 131).
- MES counts were highest during the ablation phase for all groups, and two patients experienced neurological deficits post-PFA.
Conclusions:
- PFA is associated with a higher MES count compared to HPSD RFA, with variations between different PFA catheter systems.
- Transcranial doppler monitoring highlights the ablation step as the most significant contributor to cerebral embolization in both PFA and RFA procedures.
