Technische Universität Dresden, Campus Chemnitz, Klinikum Chemnitz, Flemmingstrasse 2, 09116, Chemnitz, Germany.
Technische Universität Dresden, Heart Center Dresden, Fetscherstrasse 76, 01307, Dresden, Germany.
J Interv Card Electrophysiol. 2022 Aug;64(2):359-365. doi: 10.1007/s10840-021-01010-1. Epub 2021 May 31.
Doppler microembolic signals (MES) occur during atrial fibrillation ablation despite of permanent flushed transseptal sheaths, frequent controls of periprocedural coagulation status and the use of irrigated ablation catheters PURPOSE: To investigate the number and type of MES depending on the procedure time, prespecified procedure steps, the activated clotting time (ACT) during the ablation procedure and the catheter contact force.
In a prospective trial, 53 consecutive atrial fibrillation patients underwent pulmonary vein isolation by super-irrigated "point-by-point" ablation. All patients underwent a periinterventional, continuous transcranial Doppler examination (TCD) of the bilateral middle cerebral arteries during the complete ablation procedure.
An average of 686±226 microembolic signals were detected by permanent transcranial Doppler. Thereby, 569±208 signals were differentiated as gaseous and 117±31 as solid MES. The number of MES with regard to defined procedure steps were as follows: gaseous: [transseptal puncture, 26 ± 28; sheath flushing, 24±12; catheter change, 21±11; angiography, 101±28; mapping, 9±9; ablation, 439±192; protamine administration, 0±0]; solid: [transseptal puncture, 8±8; sheath flushing, 9±5; catheter replacement, 6±6; angiography, not measurable; mapping, 2±5; ablation, 41±22; protamine administration, 0±0]. Significantly less MES occurred with shorter procedure time, higher ACT and the use of tissue contact force monitoring.
The current study demonstrates that during atrial fibrillation ablation using irrigated, "point-by-point" RF ablation, masses of microembolic signals are detected in transcranial ultrasound especially in the period of RF current application. The number of MES depends on the total procedure time and the reached ACT during ablation. The use of contact force monitoring might reduce MES during RF ablation.
尽管使用了永久性冲洗过的经房间隔鞘管、频繁控制围手术期凝血状态以及使用灌流消融导管，在心房颤动消融过程中仍会出现多普勒微栓塞信号（MES）。目的：研究 MES 的数量和类型取决于手术时间、预设的手术步骤、消融过程中的激活凝血时间（ACT）以及导管接触力。
在一项前瞻性试验中，53 例连续的心房颤动患者接受了超灌流“逐点”消融的肺静脉隔离。所有患者在整个消融过程中都接受了双侧大脑中动脉的经颅多普勒超声（TCD）的围手术期连续监测。
永久性经颅多普勒检测到平均 686±226 个微栓塞信号。其中，569±208 个信号为气体性 MES，117±31 个信号为固体性 MES。根据定义的手术步骤，MES 的数量如下：气体性：[经房间隔穿刺，26±28；鞘管冲洗，24±12；导管更换，21±11；血管造影，101±28；标测，9±9；消融，439±192；鱼精蛋白给药，0±0]；固体性：[经房间隔穿刺，8±8；鞘管冲洗，9±5；导管更换，6±6；血管造影，无法测量；标测，2±5；消融，41±22；鱼精蛋白给药，0±0]。手术时间较短、ACT 较高和使用组织接触力监测时，MES 的数量明显减少。
本研究表明，在使用灌流、“逐点”RF 消融治疗心房颤动时，经颅超声会检测到大量的微栓塞信号，尤其是在射频电流应用期间。MES 的数量取决于总手术时间和消融过程中的达到的 ACT。使用接触力监测可能会减少 RF 消融过程中的 MES。
