Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7 Manabeshin-machi, Tsuchiura, Ibaraki 300-0053, Japan.
Europace. 2018 Feb 1;20(2):347-352. doi: 10.1093/europace/euw397.
Subclinical brain damage due to microembolization could occur during catheter ablation procedures. We evaluated the microembolic signals (MESs) detected by transcranial Doppler during ablation of supraventricular tachycardias (SVTs) or idiopathic ventricular arrhythmias (VAs) with the use of different approaches.
This study included 36 patients (23 men, 49 ± 21 years) who underwent catheter ablation of SVTs (n = 27) or idiopathic VAs (n = 9). Left-sided ablation was performed by either a transaortic (Group 1, n = 11) or transseptal approach (Group 2, n = 9). A sole right-sided ablation was performed in the remaining 16 patients (Group 3). The MESs were counted throughout the procedure, and then analysed offline with a frequency analysis. The mean number of radiofrequency applications, total energy delivery time, total application energy, and total procedure time were 5.8 ± 5.0, 4.3 ± 3.3 min, 6625 ± 4633 J, and 81 ± 40 min, respectively, and there was no significant difference in the parameters between the three groups. The mean total number of MESs was 3.8 ± 3.1 in Group 1, 75 ± 58 in Group 2, and 0.3 ± 0.6 in Group 3 (P = 0.001). Few MESs were detectable during the radiofrequency energy deliveries in all groups. In Group 2, 19 ± 18 MESs were detected during the transseptal puncture period, and subsequently a relatively even distribution of emboli formation was observed. A frequency analysis suggested that 99, 91, and 100% of MESs were gaseous, in Group 1, Group 2, and Group 3, respectively. No neurological impairment was observed in any patients after the procedure.
The retrograde aortic approach might potentially have a lower risk of subclinical brain damage than the transseptal approach during left-sided catheter ablation.
心导管消融术过程中可能会因微栓塞导致亚临床脑损伤。我们评估了经颅多普勒检测到的微栓塞信号（MESs），这些信号是在使用不同方法消融室上性心动过速（SVTs）或特发性室性心律失常（VAs）时产生的。
这项研究包括 36 名患者（23 名男性，49±21 岁），他们接受了 SVTs（n=27）或特发性 VAs（n=9）的导管消融。左侧消融通过经主动脉（第 1 组，n=11）或经房间隔（第 2 组，n=9）途径进行。其余 16 名患者（第 3 组）仅进行右侧消融。在整个手术过程中计数 MESs，并在线下进行频率分析。射频应用的平均次数、总能量输送时间、总应用能量和总手术时间分别为 5.8±5.0、4.3±3.3 分钟、6625±4633 J 和 81±40 分钟，三组之间参数无显著差异。第 1 组的平均总 MESs 数为 3.8±3.1，第 2 组为 75±58，第 3 组为 0.3±0.6（P=0.001）。在所有组中，射频能量输送期间仅可检测到少量 MESs。在第 2 组中，在经房间隔穿刺期间检测到 19±18 个 MESs，随后观察到栓塞形成的相对均匀分布。频率分析表明，第 1 组、第 2 组和第 3 组中 99%、91%和 100%的 MESs 为气态。手术后，所有患者均未出现神经功能损伤。
与经房间隔途径相比，左侧心导管消融时逆行主动脉途径可能具有较低的亚临床脑损伤风险。
