Pulmonary vein isolation procedure may be associated with intracranial artery microembolism and increased risk of acute neurological incidents

Abstract

Abstract Background Atrial fibrillation ablation can be associated with the microembolism detected in intracranial arteries and risk of acute neurological incidents. Purpose The aims of this study were a quantitative and a qualitative evaluation of microembolic signals (MES) during pulmonary vein isolation (PVI) and establishing the potential significance of MES for damage of brain assessed in radiological investigation and neurological state of patients. Methods To the prospective project we qualified patients with atrial fibrillation undergoing percutaneous pulmonary vein isolation (radiofrequency ablation / balloon cryoablation) with ultrasound monitoring of microembolisms in right middle cerebral artery. Baseline and up to 12 months post pulmonary vein isolation the neurological examination and brain MRI 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 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 microembolism generated during PVI are gaseous in nature. The cerebral microembolism associated with PVI probably result from the technical aspects of the procedure and do not cause neither the permanent brain damage in the radiological investigation nor neurological deficit. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Medical University of Silesia, Katowice, Poland - statutory work