Deneke Thomas, Nentwich Karin, Schmitt Rainer, Christhopoulos Georgios, Krug Joachim, Di Biase Luigi, Natale Andrea, Szollosi Atilla, Mugge Andreas, Muller Patrick, Dietrich Johannes W, Shin Dong-In, Kerber Sebastian, Schade Anja
Heart Center Bad Neustadt, Clinic for invasive Electrophysiology, Bad Neustadt, GER ; Ruhr-University Bochum, Bochum, GER.
Heart Center Bad Neustadt, Clinic for invasive Electrophysiology, Bad Neustadt, GER.
Indian Pacing Electrophysiol J. 2014 Oct 6;14(5):240-9. doi: 10.1016/s0972-6292(16)30795-1. eCollection 2014 Sep.
Silent cerebral events (SCE) have been identified on magnetic resonance imaging (MRI) in asymptomatic patients after atrial fibrillation (AF) ablation. Procedural determinants influencing the risk for SCE still remain unclear.
Comparing the risk for SCE depending on exchanges of catheters (ExCath) over a single transseptal sheath.
88 Patients undergoing pulmonary vein isolation (PVI) only ablation using either single-tip or balloon-based technique underwent pre- and post-ablation cerebral MRI. Ablations were either performed with double transseptal access and without exchanging catheters over the transseptal sheaths (group 1: no ExCath) or after a single transseptal access and exchanges of therapeutic and diagnostic catheters (group 2: ExCath). Differences in regard to SCE rates were analyzed. Multivariate analysis was performed to identify factors related to the risk for SCE.
Included patients underwent PVI using single tip irrigated radiofrequency in 41, endoscopic laser balloon in 27 and cryoballoon in 20 cases. Overall SCE were identified in 23 (26%) patients. In group 1 (no ExCath; N=46) 6 patients (13%) and in group 2 (N=42) 17 patients (40%) had documented SCE (p=0.007). The applied ablation technology did not affect SCE rate. In multivariate analysis age (OR 1.1, p=0.03) and catheter exchanges over a single transseptal sheath (OR 12.1, p=0.007) were the only independent predictors of a higher risk for SCE.
Exchanging catheters over a single transseptal access to perform left atrial ablation is associated with a significantly higher incidence of SCE compared to an ablation technique using different transseptal accesses for therapeutic and diagnostic catheters.
在心房颤动（AF）消融术后的无症状患者中，磁共振成像（MRI）已发现无症状性脑事件（SCE）。影响SCE风险的手术相关因素仍不清楚。
比较经单一房间隔鞘管进行导管交换（ExCath）情况下发生SCE的风险。
88例仅采用单极或球囊技术进行肺静脉隔离（PVI）消融的患者，在消融前后均接受了脑部MRI检查。消融操作要么采用双房间隔穿刺且不通过房间隔鞘管交换导管（第1组：无ExCath），要么采用单房间隔穿刺并交换治疗性和诊断性导管（第2组：ExCath）。分析两组SCE发生率的差异。进行多变量分析以确定与SCE风险相关的因素。
纳入的患者中，41例采用单极灌注射频进行PVI，27例采用内镜激光球囊，20例采用冷冻球囊。共23例（26%）患者发现了总体SCE。第1组（无ExCath；n = 46）有6例（13%）患者，第2组（n = 42）有17例（40%）患者记录到SCE（p = 0.007）。所应用的消融技术不影响SCE发生率。在多变量分析中，年龄（比值比[OR] 1.1，p = 0.03）和经单一房间隔鞘管进行导管交换（OR 12.1，p = （此处原文p值缺失））是SCE高风险的仅有的独立预测因素。
与采用不同房间隔穿刺途径分别用于治疗性和诊断性导管的消融技术相比，经单一房间隔穿刺交换导管进行左心房消融与SCE的发生率显著升高相关。
