Exchanging catheters over a single transseptal sheath during left atrial ablation is associated with a higher risk for silent cerebral events

Thomas Deneke, Karin Nentwich, Rainer Schmitt, Georgios Christhopoulos, Joachim Krug, Luigi Di Biase, Andrea Natale, Atilla Szollosi, Andreas Mugge, Patrick Muller, Johannes W. Dietrich, Dong In Shin, Sebastian Kerber, Anja Schade

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)240-249
Number of pages10
JournalIndian Pacing and Electrophysiology Journal
Volume14
Issue number5
StatePublished - Sep 1 2014
Externally publishedYes

Fingerprint

Catheters
Pulmonary Veins
Multivariate Analysis
Magnetic Resonance Imaging
Ablation Techniques
Atrial Fibrillation
Lasers
Technology
Incidence
Therapeutics

Keywords

  • Atrial fibrillation ablation
  • Magnetic resonance imaging
  • Silent cerebral lesions

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Exchanging catheters over a single transseptal sheath during left atrial ablation is associated with a higher risk for silent cerebral events. / 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.

In: Indian Pacing and Electrophysiology Journal, Vol. 14, No. 5, 01.09.2014, p. 240-249.

Research output: Contribution to journalArticle

Deneke, T, Nentwich, K, Schmitt, R, Christhopoulos, G, Krug, J, Di Biase, L, Natale, A, Szollosi, A, Mugge, A, Muller, P, Dietrich, JW, Shin, DI, Kerber, S & Schade, A 2014, 'Exchanging catheters over a single transseptal sheath during left atrial ablation is associated with a higher risk for silent cerebral events', Indian Pacing and Electrophysiology Journal, vol. 14, no. 5, pp. 240-249.
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. / Exchanging catheters over a single transseptal sheath during left atrial ablation is associated with a higher risk for silent cerebral events. In: Indian Pacing and Electrophysiology Journal. 2014 ; Vol. 14, No. 5. pp. 240-249.
@article{95a17fd003ec47b1bcaf9c385d2b62dd,
title = "Exchanging catheters over a single transseptal sheath during left atrial ablation is associated with a higher risk for silent cerebral events",
abstract = "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.",
keywords = "Atrial fibrillation ablation, Magnetic resonance imaging, Silent cerebral lesions",
author = "Thomas Deneke and Karin Nentwich and Rainer Schmitt and Georgios Christhopoulos and Joachim Krug and {Di Biase}, Luigi and Andrea Natale and Atilla Szollosi and Andreas Mugge and Patrick Muller and Dietrich, {Johannes W.} and Shin, {Dong In} and Sebastian Kerber and Anja Schade",
year = "2014",
month = "9",
day = "1",
language = "English (US)",
volume = "14",
pages = "240--249",
journal = "Indian Pacing and Electrophysiology Journal",
issn = "0972-6292",
publisher = "Indian Pacing and Electrophysiology Group",
number = "5",

}

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

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

UR - http://www.scopus.com/inward/record.url?scp=84907532052&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84907532052&partnerID=8YFLogxK

M3 - Article

VL - 14

SP - 240

EP - 249

JO - Indian Pacing and Electrophysiology Journal

JF - Indian Pacing and Electrophysiology Journal

SN - 0972-6292

IS - 5

ER -