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Cerebral microembolism during atrial fibrillation ablation can result from the technical aspects and mostly does not cause permanent neurological deficit
Archives of Medical Science ( IF 3.8 ) Pub Date : 2020-04-25 , DOI: 10.5114/aoms.2020.94747 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
Archives of Medical Science ( IF 3.8 ) Pub Date : 2020-04-25 , DOI: 10.5114/aoms.2020.94747 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
Affiliation
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.
中文翻译：
房颤消融过程中的脑微栓塞可能是技术方面的结果，并且大多不会导致永久性神经功能缺损
简介
心房颤动消融可能与颅内动脉中检测到的微栓塞和神经系统事件的风险有关。本研究的目的是评估肺静脉隔离 (PVI) 期间的微栓塞信号 (MES)，并确定 MES 在放射学检查和神经系统状态中对脑损伤的潜在意义。
材料和方法
在前瞻性研究中，我们纳入了接受经皮肺静脉隔离（射频消融/球囊冷冻消融）的房颤患者，超声监测大脑中动脉的微栓塞。所有参与者均进行了神经系统检查和头部 MRI 检查。
结果
该研究招募了 80 名患者，平均年龄为 58 岁。61 名（76.3%）患者在监测右侧大脑中动脉血流期间记录了微栓塞，数量为 51-489（平均：239）。大多数情况下，微栓子信号是在经间隔穿刺和消融阶段记录的。89% 的微栓塞是气态的。消融前整个组的 Fazekas 量表平均分：0.87 ±0.7（0-3，中 1）；之后：0.93 ±0.71。3 名 (4.3%) 患者的病变在随访期间恶化。随访期间没有患者出现心血管事件，神经系统状态也没有变化。
结论
PVI 期间产生的大多数脑微栓塞本质上是气态的。与 PVI 相关的脑微栓塞可能是由于该程序的技术方面造成的，并且在放射学检查中不会导致永久性脑损伤或神经功能缺损。
更新日期：2020-04-25
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.
中文翻译：
房颤消融过程中的脑微栓塞可能是技术方面的结果，并且大多不会导致永久性神经功能缺损
简介
心房颤动消融可能与颅内动脉中检测到的微栓塞和神经系统事件的风险有关。本研究的目的是评估肺静脉隔离 (PVI) 期间的微栓塞信号 (MES)，并确定 MES 在放射学检查和神经系统状态中对脑损伤的潜在意义。
材料和方法
在前瞻性研究中，我们纳入了接受经皮肺静脉隔离（射频消融/球囊冷冻消融）的房颤患者，超声监测大脑中动脉的微栓塞。所有参与者均进行了神经系统检查和头部 MRI 检查。
结果
该研究招募了 80 名患者，平均年龄为 58 岁。61 名（76.3%）患者在监测右侧大脑中动脉血流期间记录了微栓塞，数量为 51-489（平均：239）。大多数情况下，微栓子信号是在经间隔穿刺和消融阶段记录的。89% 的微栓塞是气态的。消融前整个组的 Fazekas 量表平均分：0.87 ±0.7（0-3，中 1）；之后：0.93 ±0.71。3 名 (4.3%) 患者的病变在随访期间恶化。随访期间没有患者出现心血管事件，神经系统状态也没有变化。
结论
PVI 期间产生的大多数脑微栓塞本质上是气态的。与 PVI 相关的脑微栓塞可能是由于该程序的技术方面造成的，并且在放射学检查中不会导致永久性脑损伤或神经功能缺损。
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