Shinsuke Miyazaki1, Tomonori Watanabe2, Takatsugu Kajiyama2, Jin Iwasawa2, Sadamitsu Ichijo2, Hiroaki Nakamura2, Hiroshi Taniguchi2, Kenzo Hirao2, Yoshito Iesaka2. 1. From the Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki (S.M., T.W., T.K., J.I., S.I., H.N., H.T., Y.I.); and Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan (K.H.). mshinsuke@k3.dion.ne.jp. 2. From the Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki (S.M., T.W., T.K., J.I., S.I., H.N., H.T., Y.I.); and Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan (K.H.).
Abstract
BACKGROUND: Atrial fibrillation ablation is associated with substantial risks of silent cerebral events (SCEs) or silent cerebral lesions. We investigated which procedural processes during cryoballoon procedures carried a risk. METHODS AND RESULTS: Forty paroxysmal atrial fibrillation patients underwent pulmonary vein isolation using second-generation cryoballoons with single 28-mm balloon 3-minute freeze techniques. Microembolic signals (MESs) were monitored by transcranial Doppler throughout all procedures. Brain magnetic resonance imaging was obtained pre- and post-procedure in 34 patients (85.0%). Of 158 pulmonary veins, 152 (96.2%) were isolated using cryoablation, and 6 required touch-up radiofrequency ablation. A mean of 5.0±1.2 cryoballoon applications was applied, and the left atrial dwell time was 76.7±22.4 minutes. The total MES counts/procedures were 522 (426-626). Left atrial access and Flexcath sheath insertion generated 25 (11-44) and 34 (24-53) MESs. Using radiofrequency ablation for transseptal access increased the MES count during transseptal punctures. During cryoapplications, MES counts were greatest during first applications (117 [81-157]), especially after balloon stretch/deflations (43 [21-81]). Pre- and post-pulmonary vein potential mapping with Lasso catheters generated 57 (21-88) and 61 (36-88) MESs. Reinsertion of once withdrawn cryoballoons and subsequent applications produced 205 (156-310) MESs. Touch-up ablation generated 32 (19-62) MESs, whereas electric cardioversion generated no MESs. SCEs and silent cerebral lesions were detected in 11 (32.3%) and 4 (11.7%) patients, respectively. The patients with SCEs were older than those without; however, there were no significant factors associated with SCEs. CONCLUSIONS: A significant number of MESs and SCE/silent cerebral lesion occurrences were observed during second-generation cryoballoon ablation procedures. MESs were recorded during a variety of steps throughout the procedure; however, the majority occurred during phases with a high probability of gaseous emboli.
BACKGROUND:Atrial fibrillation ablation is associated with substantial risks of silent cerebral events (SCEs) or silent cerebral lesions. We investigated which procedural processes during cryoballoon procedures carried a risk. METHODS AND RESULTS: Forty paroxysmal atrial fibrillationpatients underwent pulmonary vein isolation using second-generation cryoballoons with single 28-mm balloon 3-minute freeze techniques. Microembolic signals (MESs) were monitored by transcranial Doppler throughout all procedures. Brain magnetic resonance imaging was obtained pre- and post-procedure in 34 patients (85.0%). Of 158 pulmonary veins, 152 (96.2%) were isolated using cryoablation, and 6 required touch-up radiofrequency ablation. A mean of 5.0±1.2 cryoballoon applications was applied, and the left atrial dwell time was 76.7±22.4 minutes. The total MES counts/procedures were 522 (426-626). Left atrial access and Flexcath sheath insertion generated 25 (11-44) and 34 (24-53) MESs. Using radiofrequency ablation for transseptal access increased the MES count during transseptal punctures. During cryoapplications, MES counts were greatest during first applications (117 [81-157]), especially after balloon stretch/deflations (43 [21-81]). Pre- and post-pulmonary vein potential mapping with Lasso catheters generated 57 (21-88) and 61 (36-88) MESs. Reinsertion of once withdrawn cryoballoons and subsequent applications produced 205 (156-310) MESs. Touch-up ablation generated 32 (19-62) MESs, whereas electric cardioversion generated no MESs. SCEs and silent cerebral lesions were detected in 11 (32.3%) and 4 (11.7%) patients, respectively. The patients with SCEs were older than those without; however, there were no significant factors associated with SCEs. CONCLUSIONS: A significant number of MESs and SCE/silent cerebral lesion occurrences were observed during second-generation cryoballoon ablation procedures. MESs were recorded during a variety of steps throughout the procedure; however, the majority occurred during phases with a high probability of gaseous emboli.
Authors: Anetta Lasek-Bal; Przemysław Puz; Joanna Wieczorek; Seweryn Nowak; Anna Maria Wnuk-Wojnar; Aldona Warsz-Wianecka; Katarzyna Mizia-Stec Journal: Arch Med Sci Date: 2020-04-25 Impact factor: 3.318
Authors: Nikolaos Dagres; Tze-Fan Chao; Guilherme Fenelon; Luis Aguinaga; Daniel Benhayon; Emelia J Benjamin; T Jared Bunch; Lin Yee Chen; Shih-Ann Chen; Francisco Darrieux; Angelo de Paola; Laurent Fauchier; Andreas Goette; Jonathan Kalman; Lalit Kalra; Young-Hoon Kim; Deirdre A Lane; Gregory Y H Lip; Steven A Lubitz; Manlio F Márquez; Tatjana Potpara; Domingo Luis Pozzer; Jeremy N Ruskin; Irina Savelieva; Wee Siong Teo; Hung-Fat Tse; Atul Verma; Shu Zhang; Mina K Chung; William-Fernando Bautista-Vargas; Chern-En Chiang; Alejandro Cuesta; Gheorghe-Andrei Dan; David S Frankel; Yutao Guo; Robert Hatala; Young Soo Lee; Yuji Murakawa; Cara N Pellegrini; Claudio Pinho; David J Milan; Daniel P Morin; Elenir Nadalin; George Ntaios; Mukund A Prabhu; Marco Proietti; Lena Rivard; Mariana Valentino; Alena Shantsila Journal: J Arrhythm Date: 2018-03-23
Authors: Boris Schmidt; Gábor Széplaki; Bela Merkely; Josef Kautzner; Vincent van Driel; Felix Bourier; Malte Kuniss; Alan Bulava; Georg Nölker; Muchtiar Khan; Thorsten Lewalter; Norbert Klein; Beate Wenzel; Julian Kr Chun; Dipen Shah Journal: J Cardiovasc Electrophysiol Date: 2019-03-25