Asymptomatic cerebral embolization in catheter ablation of atrial fibrillation—Can it be avoided?

摘要: Cerebral embolization in invasive cardiovascular procedures is a known problem that has seen some revived attention over the past several months. In interventional electrophysiology, left atrial ablation for treatment of fibrillation (AF) most commonly performed procedure to be associated with this. Fortunately, incidence clinically manifest transient ischemic attack or cerebrovascular accidents AF low. 1 The issue asymptomatic cerebral emboli (ACE) remains significant concern, magnetic resonance imaging studies showing substantial burden acutely brain lesions. 2 long-term impact silent unknown, but it suspected contribute subtle neurological and cognitive decline, possibly dementia at later stage. 3 mechanism catheter not well understood could multifactorial. Possible contributing factors include air during transseptal puncture introduction catheters; thrombus material either preexisting (and undetected by preprocedure imaging) dislodged manipulation forming de novo, while sheaths catheters are atrium from tissue injury blood coagulum caused heating freezing case cryoablation. Modifiable among those (1) ensuring proper sheath exchange techniques adequate intraprocedural anticoagulation, reducing time spend (2) amount lesions time. advantage circular reduction covering larger area creation contiguous pulmonary vein antra.