دورية أكاديمية
Silent cerebral events/lesions after second-generation cryoballoon ablation: How can we reduce the risk of silent strokes?
| العنوان: | Silent cerebral events/lesions after second-generation cryoballoon ablation: How can we reduce the risk of silent strokes? |
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| المؤلفون: | Miyazaki S; Department of Cardiovascular medicine, Fukui University, Fukui, Japan. Electronic address: mshinsuke@k3.dion.ne.jp., Kajiyama T; Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan., Yamao K; Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan., Hada M; Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan., Yamaguchi M; Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan., Nakamura H; Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan., Hachiya H; Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan., Tada H; Department of Cardiovascular medicine, Fukui University, Fukui, Japan., Hirao K; Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan., Iesaka Y; Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan. |
| المصدر: | Heart rhythm [Heart Rhythm] 2019 Jan; Vol. 16 (1), pp. 41-48. Date of Electronic Publication: 2018 Jul 12. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: United States NLM ID: 101200317 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1556-3871 (Electronic) Linking ISSN: 15475271 NLM ISO Abbreviation: Heart Rhythm Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: New York, NY : Elsevier, c2004- |
| مواضيع طبية MeSH: | Ablation Techniques/*methods , Atrial Fibrillation/*surgery , Brain/*diagnostic imaging , Cryosurgery/*methods , Heart Conduction System/*physiopathology , Pulmonary Veins/*surgery , Stroke/*prevention & control, Asymptomatic Diseases ; Atrial Fibrillation/complications ; Female ; Heart Conduction System/surgery ; Humans ; Incidence ; Japan/epidemiology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Risk Factors ; Stroke/diagnosis ; Stroke/epidemiology ; Treatment Outcome |
| مستخلص: | Background: Atrial fibrillation (AF) ablation is associated with a substantial risk of silent cerebral events/lesions (SCEs/SCLs) detected on magnetic resonance imaging (MRI). Objective: The purpose of this study was to investigate the factors associated with the incidence of SCEs/SCLs during second-generation cryoballoon ablation. Methods: Two hundred fifty-six AF patients underwent brain MRI 1 day after pulmonary vein (PV) isolation using second-generation cryoballoons with a single 28-mm balloon and short freeze strategy. Results: Overall, 991 of 1016 PVs (97.5%) were successfully isolated by 4.9 ± 1.3 cryoballoon applications per patient, and 25 PVs required touch-up radiofrequency ablation. The total procedure time was 72.7 ± 26.1 minutes. SCEs and SCLs were detected in 68 (26.5%) and 27 (10.5%) patients, respectively. None of the patients reported any neurologic symptoms. Reinsertion of once withdrawn cryoballoons and subsequent applications significantly increased the incidence of SCEs (odds ratio [OR] 2.057; 95% confidential interval [CI] 1.051-4.028; P = .035), and additional left atrial mapping with a multielectrode catheter significantly increased the incidence of SCLs (OR 3.317; 95% CI 1.365-8.056; P = .008). Transient coronary air embolisms were significantly associated with the incidence of SCLs (OR 3.447; 95% CI 1.015-11.702; P = 0.047). On the contrary, an uninterrupted anticoagulation regimen, use of radiofrequency deliveries for transseptal access, cryoballoon air removal with extracorporeal balloon inflations, strength of the MRI magnet, internal electrical cardioversion, and touch-up ablation were not associated with the incidence of SCEs/SCLs. Conclusion: A significant number of SCE/SCL occurrences was observed after second-generation cryoballoon ablation procedures. These results suggest that air embolisms are the main mechanism of SCEs/SCLs, and the injected air volume might determine the lesion type. (Copyright © 2018 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.) |
| التعليقات: | Comment in: Heart Rhythm. 2019 Jan;16(1):49-50. (PMID: 30048692) |
| فهرسة مساهمة: | Keywords: Atrial fibrillation; Catheter ablation; Cryoballoon; Pulmonary vein isolation; Silent stroke |
| تواريخ الأحداث: | Date Created: 20180719 Date Completed: 20200902 Latest Revision: 20200902 |
| رمز التحديث: | 20240513 |
| DOI: | 10.1016/j.hrthm.2018.07.011 |
| PMID: | 30017816 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1556-3871 |
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| DOI: | 10.1016/j.hrthm.2018.07.011 |