Department of Medicine-Cardiology, University of Bonn, Sigmund Freud Strasse 25, Bonn 53105, Germany.
Europace. 2010 Jan;12(1):52-7. doi: 10.1093/europace/eup350.
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).
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.
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.
肺静脉（PV）的左心房导管消融已成为治疗心房颤动（AF）的重要治疗选择。我们旨在通过扩散加权磁共振成像（DW-MRI）来研究与 PV 导管消融相关的无症状性脑栓塞的发生率和预测因素。
我们对 53 例持续性或阵发性 AF 患者进行了前瞻性分析，这些患者接受了 PV 消融以及环肺静脉消融后 1 天的脑 MRI。对可能的人口统计学，医学，超声心动图和程序预测因素进行了栓塞事件的分析。每位患者平均消融 3.5 +/- 0.5 个 PV。在 6 例患者中，DW-MRI 在 PV 消融后描绘了新的临床无症状性微栓塞（11％）。在栓塞组中，消融前无效的抗心律失常药物数量明显更高（3.3 +/- 0.5 与 2.2 +/- 1.4，P = 0.014）。患有脑栓塞的患者更常见冠心病（CAD）（33 与 2％，P = 0.031）；左心室容积（130 +/- 12 与 103 +/- 26 mL，P = 0.002）和室间隔壁厚度（13.0 +/- 1.4 与 7.9 +/- 4.8 mm，P = 0.025）明显增加。
这项研究显示 PV 消融后存在高发生率的无症状性微栓塞事件。 CAD，左心室扩张和肥大是该并发症的潜在预测因素。
