Clinical Impact of the Microembolic Signal Burden During Catheter Ablation for Atrial Fibrillation: Just a Lot of Noise?
Objectives Microembolic signal detection by transcranial Doppler ultrasonography may be considered a surrogate for cerebral events during invasive cardiac procedures. However, the impact of the microembolic signal count during pulmonary vein isolation on the clinical outcome is not well evaluated. W...
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Veröffentlicht in: | Journal of ultrasound in medicine 2018-05, Vol.37 (5), p.1091-1101 |
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creator | von Bary, Christian Deneke, Thomas Arentz, Thomas Schade, Anja Lehrmann, Heiko Schwab‐Malek, Susanne Fredersdorf, Sabine Baldaranov, Dobri Maier, Lars Schlachetzki, Felix |
description | Objectives
Microembolic signal detection by transcranial Doppler ultrasonography may be considered a surrogate for cerebral events during invasive cardiac procedures. However, the impact of the microembolic signal count during pulmonary vein isolation on the clinical outcome is not well evaluated. We investigated the effect of the microembolic signal count on the occurrence of new silent cerebral embolism measured by diffusion‐weighted imaging (DWI)‐magnetic resonance imaging (MRI), changes in neuropsychological testing, and the occurrence of clinical events during long‐term follow‐up after pulmonary vein isolation.
Methods
Pulmonary vein isolation was performed in 41 patients. The total microembolic signal burden (classified into “solid,” “gaseous,” and “equivocal”) and sustained thromboembolic showers of greater than 30 seconds were recorded. Diffusion‐weighted imaging‐MRI and neuropsychological testing were performed before and after pulmonary vein isolation to assess for silent cerebral embolism and neuropsychological sequelae. Long‐term follow‐up was performed by telephone to assess for stroke/transient ischemic attack.
Results
A total of 68,729 microembolic signals (14,893 solid, 11,909 gaseous, and 41,927 equivocal) with an average of 1676 signals per patient and 42 thromboembolic showers were recorded. No correlation between the microembolic signal/thromboembolic shower count and the occurrence of new DWI lesions or neuropsychological capability was found. After a mean follow‐up ± SD of 49 ± 4 months, 1 patient had an overt transient ischemic event, which was not associated with a high microembolic signal count.
Conclusions
In this multicenter study, we found no impact of the intraprocedural microembolic symbol/thromboembolic shower count on the occurrence of new DWI lesions, neuropsychological capability, or overt neurologic deficits after pulmonary vein isolation. Thus, not only the microembolic signal count but also procedural/individual factors may contribute to commensurable clinical damage, which may challenge this method as a valid biomarker during pulmonary vein isolation. |
doi_str_mv | 10.1002/jum.14447 |
format | Article |
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Microembolic signal detection by transcranial Doppler ultrasonography may be considered a surrogate for cerebral events during invasive cardiac procedures. However, the impact of the microembolic signal count during pulmonary vein isolation on the clinical outcome is not well evaluated. We investigated the effect of the microembolic signal count on the occurrence of new silent cerebral embolism measured by diffusion‐weighted imaging (DWI)‐magnetic resonance imaging (MRI), changes in neuropsychological testing, and the occurrence of clinical events during long‐term follow‐up after pulmonary vein isolation.
Methods
Pulmonary vein isolation was performed in 41 patients. The total microembolic signal burden (classified into “solid,” “gaseous,” and “equivocal”) and sustained thromboembolic showers of greater than 30 seconds were recorded. Diffusion‐weighted imaging‐MRI and neuropsychological testing were performed before and after pulmonary vein isolation to assess for silent cerebral embolism and neuropsychological sequelae. Long‐term follow‐up was performed by telephone to assess for stroke/transient ischemic attack.
Results
A total of 68,729 microembolic signals (14,893 solid, 11,909 gaseous, and 41,927 equivocal) with an average of 1676 signals per patient and 42 thromboembolic showers were recorded. No correlation between the microembolic signal/thromboembolic shower count and the occurrence of new DWI lesions or neuropsychological capability was found. After a mean follow‐up ± SD of 49 ± 4 months, 1 patient had an overt transient ischemic event, which was not associated with a high microembolic signal count.
Conclusions
In this multicenter study, we found no impact of the intraprocedural microembolic symbol/thromboembolic shower count on the occurrence of new DWI lesions, neuropsychological capability, or overt neurologic deficits after pulmonary vein isolation. Thus, not only the microembolic signal count but also procedural/individual factors may contribute to commensurable clinical damage, which may challenge this method as a valid biomarker during pulmonary vein isolation.</description><identifier>ISSN: 0278-4297</identifier><identifier>EISSN: 1550-9613</identifier><identifier>DOI: 10.1002/jum.14447</identifier><identifier>PMID: 29034496</identifier><language>eng</language><publisher>England</publisher><subject>ablation ; Aged ; atrial fibrillation ; Atrial Fibrillation - complications ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - surgery ; Catheter Ablation - methods ; Female ; Follow-Up Studies ; Humans ; Intracranial Embolism - complications ; Intracranial Embolism - diagnosis ; Intracranial Embolism - physiopathology ; intraoperative ; invasive techniques ; Magnetic Resonance Imaging ; Male ; Neuropsychological Tests ; neuropsychology ; Prospective Studies ; Pulmonary Veins - diagnostic imaging ; Pulmonary Veins - physiopathology ; Risk Factors ; Signal Processing, Computer-Assisted ; transcranial Doppler (adult) ; Ultrasonography, Doppler, Transcranial - methods</subject><ispartof>Journal of ultrasound in medicine, 2018-05, Vol.37 (5), p.1091-1101</ispartof><rights>2017 by the American Institute of Ultrasound in Medicine</rights><rights>2017 by the American Institute of Ultrasound in Medicine.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3257-d0c5069f8c08c32acfd78e6ad502b5333c37e3d286133d1707af055b0711c44d3</citedby><cites>FETCH-LOGICAL-c3257-d0c5069f8c08c32acfd78e6ad502b5333c37e3d286133d1707af055b0711c44d3</cites><orcidid>0000-0003-0008-0541</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fjum.14447$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fjum.14447$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29034496$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>von Bary, Christian</creatorcontrib><creatorcontrib>Deneke, Thomas</creatorcontrib><creatorcontrib>Arentz, Thomas</creatorcontrib><creatorcontrib>Schade, Anja</creatorcontrib><creatorcontrib>Lehrmann, Heiko</creatorcontrib><creatorcontrib>Schwab‐Malek, Susanne</creatorcontrib><creatorcontrib>Fredersdorf, Sabine</creatorcontrib><creatorcontrib>Baldaranov, Dobri</creatorcontrib><creatorcontrib>Maier, Lars</creatorcontrib><creatorcontrib>Schlachetzki, Felix</creatorcontrib><title>Clinical Impact of the Microembolic Signal Burden During Catheter Ablation for Atrial Fibrillation: Just a Lot of Noise?</title><title>Journal of ultrasound in medicine</title><addtitle>J Ultrasound Med</addtitle><description>Objectives
Microembolic signal detection by transcranial Doppler ultrasonography may be considered a surrogate for cerebral events during invasive cardiac procedures. However, the impact of the microembolic signal count during pulmonary vein isolation on the clinical outcome is not well evaluated. We investigated the effect of the microembolic signal count on the occurrence of new silent cerebral embolism measured by diffusion‐weighted imaging (DWI)‐magnetic resonance imaging (MRI), changes in neuropsychological testing, and the occurrence of clinical events during long‐term follow‐up after pulmonary vein isolation.
Methods
Pulmonary vein isolation was performed in 41 patients. The total microembolic signal burden (classified into “solid,” “gaseous,” and “equivocal”) and sustained thromboembolic showers of greater than 30 seconds were recorded. Diffusion‐weighted imaging‐MRI and neuropsychological testing were performed before and after pulmonary vein isolation to assess for silent cerebral embolism and neuropsychological sequelae. Long‐term follow‐up was performed by telephone to assess for stroke/transient ischemic attack.
Results
A total of 68,729 microembolic signals (14,893 solid, 11,909 gaseous, and 41,927 equivocal) with an average of 1676 signals per patient and 42 thromboembolic showers were recorded. No correlation between the microembolic signal/thromboembolic shower count and the occurrence of new DWI lesions or neuropsychological capability was found. After a mean follow‐up ± SD of 49 ± 4 months, 1 patient had an overt transient ischemic event, which was not associated with a high microembolic signal count.
Conclusions
In this multicenter study, we found no impact of the intraprocedural microembolic symbol/thromboembolic shower count on the occurrence of new DWI lesions, neuropsychological capability, or overt neurologic deficits after pulmonary vein isolation. Thus, not only the microembolic signal count but also procedural/individual factors may contribute to commensurable clinical damage, which may challenge this method as a valid biomarker during pulmonary vein isolation.</description><subject>ablation</subject><subject>Aged</subject><subject>atrial fibrillation</subject><subject>Atrial Fibrillation - complications</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Fibrillation - surgery</subject><subject>Catheter Ablation - methods</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Intracranial Embolism - complications</subject><subject>Intracranial Embolism - diagnosis</subject><subject>Intracranial Embolism - physiopathology</subject><subject>intraoperative</subject><subject>invasive techniques</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Neuropsychological Tests</subject><subject>neuropsychology</subject><subject>Prospective Studies</subject><subject>Pulmonary Veins - diagnostic imaging</subject><subject>Pulmonary Veins - physiopathology</subject><subject>Risk Factors</subject><subject>Signal Processing, Computer-Assisted</subject><subject>transcranial Doppler (adult)</subject><subject>Ultrasonography, Doppler, Transcranial - methods</subject><issn>0278-4297</issn><issn>1550-9613</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10L1OwzAUBWALgaD8DLwA8ghD4Dq244QFQaFA1cIAzJHjOMVVEhc7EfD2GFLYmKx79enI9yB0SOCUAMRny745JYwxsYFGhHOIsoTQTTSCWKQRizOxg3a9XwYKRLBttBNnQBnLkhH6GNemNUrW-L5ZSdVhW-HuVeO5Uc7qprC1UfjJLNogrnpX6hZf9860CzyWwXXa4cuilp2xLa5sGDpnAp2Ywpl62J_jae87LPHM_sQ_WOP1xT7aqmTt9cH63UMvk5vn8V00e7y9H1_OIkVjLqISFIckq1IFadhIVZUi1YksOcQFp5QqKjQt4zRcTEsiQMgKOC9AEKIYK-keOh5yV86-9dp3eWO80uFvrba9z0nGCU8YAA_0ZKDhdO-drvKVM410nzmB_LvoPBSd_xQd7NE6ti8aXf7J32YDOBvAu6n15_9J-fRlPkR-AehIhto</recordid><startdate>201805</startdate><enddate>201805</enddate><creator>von Bary, Christian</creator><creator>Deneke, Thomas</creator><creator>Arentz, Thomas</creator><creator>Schade, Anja</creator><creator>Lehrmann, Heiko</creator><creator>Schwab‐Malek, Susanne</creator><creator>Fredersdorf, Sabine</creator><creator>Baldaranov, Dobri</creator><creator>Maier, Lars</creator><creator>Schlachetzki, Felix</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0008-0541</orcidid></search><sort><creationdate>201805</creationdate><title>Clinical Impact of the Microembolic Signal Burden During Catheter Ablation for Atrial Fibrillation: Just a Lot of Noise?</title><author>von Bary, Christian ; Deneke, Thomas ; Arentz, Thomas ; Schade, Anja ; Lehrmann, Heiko ; Schwab‐Malek, Susanne ; Fredersdorf, Sabine ; Baldaranov, Dobri ; Maier, Lars ; Schlachetzki, Felix</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3257-d0c5069f8c08c32acfd78e6ad502b5333c37e3d286133d1707af055b0711c44d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>ablation</topic><topic>Aged</topic><topic>atrial fibrillation</topic><topic>Atrial Fibrillation - complications</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Atrial Fibrillation - surgery</topic><topic>Catheter Ablation - methods</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Intracranial Embolism - complications</topic><topic>Intracranial Embolism - diagnosis</topic><topic>Intracranial Embolism - physiopathology</topic><topic>intraoperative</topic><topic>invasive techniques</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Neuropsychological Tests</topic><topic>neuropsychology</topic><topic>Prospective Studies</topic><topic>Pulmonary Veins - diagnostic imaging</topic><topic>Pulmonary Veins - physiopathology</topic><topic>Risk Factors</topic><topic>Signal Processing, Computer-Assisted</topic><topic>transcranial Doppler (adult)</topic><topic>Ultrasonography, Doppler, Transcranial - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>von Bary, Christian</creatorcontrib><creatorcontrib>Deneke, Thomas</creatorcontrib><creatorcontrib>Arentz, Thomas</creatorcontrib><creatorcontrib>Schade, Anja</creatorcontrib><creatorcontrib>Lehrmann, Heiko</creatorcontrib><creatorcontrib>Schwab‐Malek, Susanne</creatorcontrib><creatorcontrib>Fredersdorf, Sabine</creatorcontrib><creatorcontrib>Baldaranov, Dobri</creatorcontrib><creatorcontrib>Maier, Lars</creatorcontrib><creatorcontrib>Schlachetzki, Felix</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of ultrasound in medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>von Bary, Christian</au><au>Deneke, Thomas</au><au>Arentz, Thomas</au><au>Schade, Anja</au><au>Lehrmann, Heiko</au><au>Schwab‐Malek, Susanne</au><au>Fredersdorf, Sabine</au><au>Baldaranov, Dobri</au><au>Maier, Lars</au><au>Schlachetzki, Felix</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical Impact of the Microembolic Signal Burden During Catheter Ablation for Atrial Fibrillation: Just a Lot of Noise?</atitle><jtitle>Journal of ultrasound in medicine</jtitle><addtitle>J Ultrasound Med</addtitle><date>2018-05</date><risdate>2018</risdate><volume>37</volume><issue>5</issue><spage>1091</spage><epage>1101</epage><pages>1091-1101</pages><issn>0278-4297</issn><eissn>1550-9613</eissn><abstract>Objectives
Microembolic signal detection by transcranial Doppler ultrasonography may be considered a surrogate for cerebral events during invasive cardiac procedures. However, the impact of the microembolic signal count during pulmonary vein isolation on the clinical outcome is not well evaluated. We investigated the effect of the microembolic signal count on the occurrence of new silent cerebral embolism measured by diffusion‐weighted imaging (DWI)‐magnetic resonance imaging (MRI), changes in neuropsychological testing, and the occurrence of clinical events during long‐term follow‐up after pulmonary vein isolation.
Methods
Pulmonary vein isolation was performed in 41 patients. The total microembolic signal burden (classified into “solid,” “gaseous,” and “equivocal”) and sustained thromboembolic showers of greater than 30 seconds were recorded. Diffusion‐weighted imaging‐MRI and neuropsychological testing were performed before and after pulmonary vein isolation to assess for silent cerebral embolism and neuropsychological sequelae. Long‐term follow‐up was performed by telephone to assess for stroke/transient ischemic attack.
Results
A total of 68,729 microembolic signals (14,893 solid, 11,909 gaseous, and 41,927 equivocal) with an average of 1676 signals per patient and 42 thromboembolic showers were recorded. No correlation between the microembolic signal/thromboembolic shower count and the occurrence of new DWI lesions or neuropsychological capability was found. After a mean follow‐up ± SD of 49 ± 4 months, 1 patient had an overt transient ischemic event, which was not associated with a high microembolic signal count.
Conclusions
In this multicenter study, we found no impact of the intraprocedural microembolic symbol/thromboembolic shower count on the occurrence of new DWI lesions, neuropsychological capability, or overt neurologic deficits after pulmonary vein isolation. Thus, not only the microembolic signal count but also procedural/individual factors may contribute to commensurable clinical damage, which may challenge this method as a valid biomarker during pulmonary vein isolation.</abstract><cop>England</cop><pmid>29034496</pmid><doi>10.1002/jum.14447</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-0008-0541</orcidid></addata></record> |
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subjects | ablation Aged atrial fibrillation Atrial Fibrillation - complications Atrial Fibrillation - physiopathology Atrial Fibrillation - surgery Catheter Ablation - methods Female Follow-Up Studies Humans Intracranial Embolism - complications Intracranial Embolism - diagnosis Intracranial Embolism - physiopathology intraoperative invasive techniques Magnetic Resonance Imaging Male Neuropsychological Tests neuropsychology Prospective Studies Pulmonary Veins - diagnostic imaging Pulmonary Veins - physiopathology Risk Factors Signal Processing, Computer-Assisted transcranial Doppler (adult) Ultrasonography, Doppler, Transcranial - methods |
title | Clinical Impact of the Microembolic Signal Burden During Catheter Ablation for Atrial Fibrillation: Just a Lot of Noise? |
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