TY - JOUR
T1 - Exchanging catheters over a single transseptal sheath during left atrial ablation is associated with a higher risk for silent cerebral events
AU - Deneke, Thomas
AU - Nentwich, Karin
AU - Schmitt, Rainer
AU - Christhopoulos, Georgios
AU - Krug, Joachim
AU - Di Biase, Luigi
AU - Natale, Andrea
AU - Szollosi, Atilla
AU - Mugge, Andreas
AU - Muller, Patrick
AU - Dietrich, Johannes W.
AU - Shin, Dong In
AU - Kerber, Sebastian
AU - Schade, Anja
N1 - Publisher Copyright:
© 2014, Indian Pacing and Electrophysiology Group. All rights reserved.
PY - 2014/9/1
Y1 - 2014/9/1
N2 - Background: Silent cerebral events (SCE) have been identified on magnetic resonance imaging (MRI) in asymptomatic patients afterb atrial fibrillation (AF) ablation. Procedural determinants influencing the risk for SCE still remain unclear.Objective: Comparing the risk for SCE depending on exchanges of catheters (ExCath) over a single transseptal sheath.Results: 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.Methods: 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.Conclusions: 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.
AB - Background: Silent cerebral events (SCE) have been identified on magnetic resonance imaging (MRI) in asymptomatic patients afterb atrial fibrillation (AF) ablation. Procedural determinants influencing the risk for SCE still remain unclear.Objective: Comparing the risk for SCE depending on exchanges of catheters (ExCath) over a single transseptal sheath.Results: 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.Methods: 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.Conclusions: 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.
KW - Atrial fibrillation ablation
KW - Magnetic resonance imaging
KW - Silent cerebral lesions
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U2 - 10.1016/S0972-6292(16)30795-1
DO - 10.1016/S0972-6292(16)30795-1
M3 - Article
AN - SCOPUS:84907532052
SN - 0972-6292
VL - 14
SP - 240
EP - 249
JO - Indian Pacing and Electrophysiology Journal
JF - Indian Pacing and Electrophysiology Journal
IS - 5
ER -