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Europace Advance Access published online on November 20, 2009
Europace, doi:10.1093/europace/eup350
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

CLINICAL RESEARCH

Incidence and predictors of silent cerebral embolism during pulmonary vein catheter ablation for atrial fibrillation

Jan Wilko Schrickel1,* {dagger}, Lars Lickfett1 {dagger}, Thorsten Lewalter1, Erica Mittman-Braun1, Stephanie Selbach1, Katharina Strach2, Claas P. Nähle2, Jörg Otto Schwab1, Markus Linhart1, Rene Andrié1, Georg Nickenig1 and Torsten Sommer2

1 Department of Medicine-Cardiology, University of Bonn, Sigmund Freud Strasse 25, Bonn 53105, Germany; 2 Department of Radiology, University of Bonn, Bonn, Germany

Aims: Left atrial catheter ablation of the pulmonary veins (PV) has evolved as an important therapeutic option for the treatment of atrial fibrillation (AF). We aimed to investigate the incidence and predictors of silent cerebral embolism associated with PV catheter ablation, detected by diffusion-weighted magnetic resonance imaging (DW-MRI).

Methods and results: We performed a prospective analysis of 53 consecutive patients with persistent or paroxysmal AF that underwent PV ablation and post-procedural cerebral MRI 1 day after lasso catheter-guided ostial PV ablation. Patients were analysed for possible demographical, medical, echocardiographical, and procedural predictors of embolic events. A mean of 3.5 ± 0.5 PVs were ablated per patient. In six patients, DW-MRI depicted new clinically silent microembolism after PV ablation (11%). The number of ineffective medical antiarrhythmic agents prior to ablation procedure was significantly higher in the embolism group (3.3 ± 0.5 vs. 2.2 ± 1.4, P = 0.014). Coronary heart disease (CAD) was more frequent in patients with cerebral embolisms (33 vs. 2%, P = 0.031); left ventricular volume (130 ± 12 vs. 103 ± 26 mL, P = 0.002), and septal wall thickness (13.0 ± 1.4 vs. 7.9 ± 4.8 mm, P = 0.025) were significantly increased.

Conclusion: This study shows a high incidence of silent micro-embolic events after PV ablation. CAD, left ventricular dilatation, and hypertrophy were potential predictors of this complication.

Key Words: Atrial fibrillation, Pulmonary vein ablation, Cerebral thromboembolism, MRI

* Corresponding author. Tel: +49 228 287 16670, Fax: +49 228 287 14983, Email: jan.schrickel{at}ukb.uni-bonn.de

{dagger} The first two authors contributed equally to the study.

Manuscript submitted 1 July 2009. Accepted after revision 12 October 2009.


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