Cerebral micro-embolization during pulmonary vein isolation: Relation to post-ablation silent cerebral ischemia

Edina Nagy-Baló, Mihran Martirosyan, Gábor Sándorfi, Orsolya Hajas, Levente Lánczi, Ervin Berényi, Lilla Ladányi, Alexandra Kiss, I. Édes, Zoltán Csanádi

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Abstract

Background: High incidences of silent cerebral ischemia (SCI) have been revealed by diffusion-weighted magnetic resonance imaging (DW MRI) after pulmonary vein isolation (PVI) for atrial fibrillation. A high number of mostly gaseous micro-embolic signals (MESs) was detected by transcranial Doppler (TCD) during PVI. In this investigation the possible relationship between MESs detected intraoperatively by TCD and new SCI on DW MRI post-ablation is reported. Methods: 27 consecutive atrial fibrillation patients (6 female, age median: 64 interquartile range: 13.23) undergoing PVI with the pulmonary vein ablation catheter, pre- and post-ablation DW MRI and intraoperative MES detection by TCD were included in the study. Procedures were performed on a therapeutic international normalized ratio (2–3) and with a target activated clotting time ≥ 350 s in all patients. DW MRI scans performed pre- and post-ablation revealed new SCI in 6 out of 27 (22%) patients. Results: The median (interquartile range) MES count recorded during the whole procedure was 1642 (912) in patients with and 1019 (529) in those without SCI (p = 0.129). The number of MESs recorded during pulmonary vein angiography was significantly higher in patients as compared to those without a new lesion on the post-ablation DW MRI: 257 (249) vs. 110 (71), respectively (p = 0.0009). On multivariate logistic regression, the total MES count was predictive of SCI in patients older than 68 years. Conclusions: Micro-embolus generation detected by TCD during pulmonary vein angiography significantly correlates with new SCI on DW MRI post-ablation.

Original languageEnglish
Pages (from-to)234-241
Number of pages8
JournalCardiology Journal
Volume24
Issue number3
DOIs
Publication statusPublished - Jan 1 2017

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Diffusion Magnetic Resonance Imaging
Pulmonary Veins
Brain Ischemia
Atrial Fibrillation
Angiography
International Normalized Ratio
Catheter Ablation
Embolism
Logistic Models
Incidence

Keywords

  • Diffusion-weighted magnetic resonance imaging
  • Microembolic signals
  • Silent cerebral ischemia
  • Transcranial Doppler

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Nagy-Baló, E., Martirosyan, M., Sándorfi, G., Hajas, O., Lánczi, L., Berényi, E., ... Csanádi, Z. (2017). Cerebral micro-embolization during pulmonary vein isolation: Relation to post-ablation silent cerebral ischemia. Cardiology Journal, 24(3), 234-241. https://doi.org/10.5603/CJ.a2017.0030

Cerebral micro-embolization during pulmonary vein isolation : Relation to post-ablation silent cerebral ischemia. / Nagy-Baló, Edina; Martirosyan, Mihran; Sándorfi, Gábor; Hajas, Orsolya; Lánczi, Levente; Berényi, Ervin; Ladányi, Lilla; Kiss, Alexandra; Édes, I.; Csanádi, Zoltán.

In: Cardiology Journal, Vol. 24, No. 3, 01.01.2017, p. 234-241.

Research output: Contribution to journalArticle

Nagy-Baló, E, Martirosyan, M, Sándorfi, G, Hajas, O, Lánczi, L, Berényi, E, Ladányi, L, Kiss, A, Édes, I & Csanádi, Z 2017, 'Cerebral micro-embolization during pulmonary vein isolation: Relation to post-ablation silent cerebral ischemia', Cardiology Journal, vol. 24, no. 3, pp. 234-241. https://doi.org/10.5603/CJ.a2017.0030
Nagy-Baló, Edina ; Martirosyan, Mihran ; Sándorfi, Gábor ; Hajas, Orsolya ; Lánczi, Levente ; Berényi, Ervin ; Ladányi, Lilla ; Kiss, Alexandra ; Édes, I. ; Csanádi, Zoltán. / Cerebral micro-embolization during pulmonary vein isolation : Relation to post-ablation silent cerebral ischemia. In: Cardiology Journal. 2017 ; Vol. 24, No. 3. pp. 234-241.
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abstract = "Background: High incidences of silent cerebral ischemia (SCI) have been revealed by diffusion-weighted magnetic resonance imaging (DW MRI) after pulmonary vein isolation (PVI) for atrial fibrillation. A high number of mostly gaseous micro-embolic signals (MESs) was detected by transcranial Doppler (TCD) during PVI. In this investigation the possible relationship between MESs detected intraoperatively by TCD and new SCI on DW MRI post-ablation is reported. Methods: 27 consecutive atrial fibrillation patients (6 female, age median: 64 interquartile range: 13.23) undergoing PVI with the pulmonary vein ablation catheter, pre- and post-ablation DW MRI and intraoperative MES detection by TCD were included in the study. Procedures were performed on a therapeutic international normalized ratio (2–3) and with a target activated clotting time ≥ 350 s in all patients. DW MRI scans performed pre- and post-ablation revealed new SCI in 6 out of 27 (22{\%}) patients. Results: The median (interquartile range) MES count recorded during the whole procedure was 1642 (912) in patients with and 1019 (529) in those without SCI (p = 0.129). The number of MESs recorded during pulmonary vein angiography was significantly higher in patients as compared to those without a new lesion on the post-ablation DW MRI: 257 (249) vs. 110 (71), respectively (p = 0.0009). On multivariate logistic regression, the total MES count was predictive of SCI in patients older than 68 years. Conclusions: Micro-embolus generation detected by TCD during pulmonary vein angiography significantly correlates with new SCI on DW MRI post-ablation.",
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AU - Hajas, Orsolya

AU - Lánczi, Levente

AU - Berényi, Ervin

AU - Ladányi, Lilla

AU - Kiss, Alexandra

AU - Édes, I.

AU - Csanádi, Zoltán

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N2 - Background: High incidences of silent cerebral ischemia (SCI) have been revealed by diffusion-weighted magnetic resonance imaging (DW MRI) after pulmonary vein isolation (PVI) for atrial fibrillation. A high number of mostly gaseous micro-embolic signals (MESs) was detected by transcranial Doppler (TCD) during PVI. In this investigation the possible relationship between MESs detected intraoperatively by TCD and new SCI on DW MRI post-ablation is reported. Methods: 27 consecutive atrial fibrillation patients (6 female, age median: 64 interquartile range: 13.23) undergoing PVI with the pulmonary vein ablation catheter, pre- and post-ablation DW MRI and intraoperative MES detection by TCD were included in the study. Procedures were performed on a therapeutic international normalized ratio (2–3) and with a target activated clotting time ≥ 350 s in all patients. DW MRI scans performed pre- and post-ablation revealed new SCI in 6 out of 27 (22%) patients. Results: The median (interquartile range) MES count recorded during the whole procedure was 1642 (912) in patients with and 1019 (529) in those without SCI (p = 0.129). The number of MESs recorded during pulmonary vein angiography was significantly higher in patients as compared to those without a new lesion on the post-ablation DW MRI: 257 (249) vs. 110 (71), respectively (p = 0.0009). On multivariate logistic regression, the total MES count was predictive of SCI in patients older than 68 years. Conclusions: Micro-embolus generation detected by TCD during pulmonary vein angiography significantly correlates with new SCI on DW MRI post-ablation.

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KW - Microembolic signals

KW - Silent cerebral ischemia

KW - Transcranial Doppler

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