Cerebral microembolism during atrial fibrillation ablation can result from the technical aspects and mostly does not cause permanent neurological deficit.

INTRODUCTION: Atrial fibrillation ablation can be associated with microembolism detected in the intracranial arteries and risk of neurological incidents. The aims of this study were to evaluate microembolic signals (MES) during pulmonary vein isolation (PVI) and establish the potential significance of MES for damage of the brain in radiological investigation and neurological state. MATERIAL AND METHODS: In the prospective study we included patients with atrial fibrillation undergoing percutaneous pulmonary vein isolation (radiofrequency ablation/balloon cryoablation) with ultrasound monitoring of microembolisms in the middle cerebral artery. Neurological examination and MRI of the head were performed in all participants. RESULTS: The study enrolled 80 patients at a mean age of 58 years. Microembolisms during the monitoring of the flow in the right middle cerebral artery were recorded in 61 (76.3%) patients in the amount of 51-489 (mean: 239). Most often the microembolic signals were registered during the trans-septal puncture and the stage of ablation. In 89%, microembolisms were gaseous. Mean score on the Fazekas scale for the whole group before ablation: 0.87 ±0.7 (0-3, med. 1); after: 0.93 ±0.71. In 3 (4.3%) patients the lesions worsened during the follow-up period. None of the patients revealed a cardiovascular event during the follow-up period and no changes were observed in the neurological status. CONCLUSIONS: The majority of cerebral microembolisms generated during PVI are gaseous in nature. The cerebral microembolisms associated with PVI probably result from the technical aspects of the procedure and do not cause either permanent brain damage in the radiological investigation or neurological deficit.

Quality of life in patients with paroxysmal atrial fibrillation after circumferential pulmonary vein ablation.

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia and is associated with a deterioration of quality of life (QoL). Catheter ablation is a therapeutic strategy for some patients with AF. The effectiveness of pulmonary vein isolation is still under assessment. AIM: To assess the long-term influence of circumferential pulmonary vein ablation (CPVA) on QoL in patients with AF. METHODS: The study population consisted of 33 patients (26 males, age 54.2 ± 9 years) with highly symptomatic (EHRA II-III) drug refractory paroxysmal AF, who underwent CPVA. A clinical examination, electrocardiogram (ECG), and Holter ECG were performed before and during a one-year follow-up. The SF-36 Medical Outcomes Survey Short-Form QoL questionnaire, scored on a 0-100 scale for each of eight domains: bodily pain (BP), general health (GH), mental health (MH), physical functioning (PF), role-emotional (RE), role-physical (RP), social functioning (SF), and vitality (V), was collected before and one year after CPVA. RESULTS: In the one-year follow-up 27 (82%) patients were free of AF. EHRA symptoms were improved one-year after CPVA regardless of CPVA efficacy. After the follow-up the SF-36 questionnaire results improved significantly in all of the subscales in patients without a recurrence of AF after CPVA. In subjects with a recurrence of AF, all of the subscales did not indicate any statistically significant differences. There was an association between the CPVA and the following QoL domains: GH (p = 0.018), PF (p = 0.042), and V (p = 0.041). The highest values of the GH and V domains were found in the non-recurrence patients one year after CPVA. CONCLUSIONS: CPVA results in the clinical improvement of patients with symptomatic AF regardless of the final arrhythmia termination. Patients after successful CPVA experienced a significant improvement in all of the subscales of the QoL.

Differentiation of arrhythmia originating from the right or left ventricular outflow tract based on the QRS morphology of premature ventricular beats and duration of repolarisation.

BACKGROUND: Premature ventricular beats (PVBs) and monomorphic ventricular tachycardia originating from the right ventricular outflow tract (RVOT) are the most frequent forms of idiopathic ventricular arrhythmias, but arrhythmia originating from the left ventricular outflow tract (LVOT) may be found in about 10% of these patients. AIM: To compare electrocardiographic (ECG) patterns and duration of repolarisation after PVBs originating from the left and right superior part of the interventricular septum which were successfully treated with radiofrequency catheter ablation. METHODS: We studied 62 patients who did not receive antiarrhythmic drug treatment before ablation, including 50 patients with RVOT arrhythmia (21 males, mean age 42 ± 14 years, left ventricular ejection fraction [LVEF] 61 ± 6%) and 12 patients with LVOT arrhythmia (3 males, mean age 41 ± 17 years, LVEF 59 ± 9%). Pre-ablation 24-h Holter ECG recordings were analysed for the total number of PVBs. In addition, we evaluated ectopic beat QRS duration, prematurity index and duration of repolarisation (QT interval, JT interval and TpeakTend values uncorrected for the heart rate) based on ten random daytime PVBs during a period of stable sinus rhythm at a rate of 60-70 bpm. RESULTS: The study groups did not differ by age, LVEF, heart rate and the number of PVBs. RVOT arrhythmia was characterised by a lower prematurity index (0.59 ± 0.11 vs. 0.72 ± 0.09, p = 0.001) and a lower R/S ratio in leads V1-V3 (p < 0.01 for each lead). QRS duration of right-sided PVBs was shorter compared to that of left-sided PVBs (147 ± 13 vs. 166 ± 13 ms, p = 0.002), QT and JT intervals were similar (QT: 422 ± 32 vs. 429 ± 27 ms, p = 0.35; JT: 272 ± 27 vs. 266 ± 27 ms, p = 0.31), and TpeakTend was shorter in RVOT arrhythmia (100 ± 10 vs. 110 ± 6 ms, p = 0.01). Combination of R > S in lead V3 and TpeakTend-PVB > 110 ms identified LVOT arrhythmia with a sensitivity of 75% and specificity of 96%. CONCLUSIONS: Ventricular arrhythmias originating from the left or right superior part of the interventricular septum are not only characterised by different ECG patterns of ventricular ectopic beats but also show significant differences in the repolarisation phase.

Correlation between electrical and mechanical properties of the left ventricle in patients with postinfarction ventricular tachycardia.

BACKGROUND: Electroanatomical mapping allows differentiation between viable and scarred myocardium. Echocardiography is widely used to assess myocardial contractility. The relationship between electrophysiological and echocardiographic assessment of left ventricular function has not yet been well established. AIM: To correlate mechanical and electrical function of the left ventricle in patients with postinfarction ventricular tachycardia and to assess clinical, echocardiographic and angiographic parameters affecting regional electrical function. METHODS: In 32 patients (25 males, 64+/-9 years old) mean unipolar (UP) and bipolar (BP) voltages were obtained with electroanatomical mapping (CARTO system) for a 12-segment model and compared with segmental wall motion function scored as normal, hypokinetic and a- or dyskinetic. UP voltage in individual groups of segments was: 7.8+/-4.2 mV, 6.5+/-4.2 mV, 4.7+/-2.5 mV, p <0.01 and for BP voltage 2.1+/-1.5 mV, 1.9+/-1.9 mV, 1.1+/-1.0 mV, p < 0.01, respectively. Left ventricular ejection fraction < or =30%, end-diastolic diameter >56 mm, previous inferior or anterior myocardial infarction (MI), MI < or =5 years and open infarct-related artery were associated with lower voltage in normokinetic segments. CONCLUSIONS: Segments with advanced systolic dysfunction had significantly lower uni- and bipolar voltage than normo- and hypokinetic segments. However, preserved local electrical function could be found in a/dyskinetic regions. Left ventricular remodelling, time and location of MI and patency of infarct-related artery influenced voltage in normokinetic segments.

Circumferential pulmonary vein RF ablation in the treatment of atrial fibrillation: 3-year experience of one centre.

INTRODUCTION: In patients with atrial fibrillation (AF), significantly symptomatic in particular, restoring and maintaining sinus rhythm is one of treatment strategies. Considering the limited efficacy and side effects of anti-arrhythmic agents, growing hopes are attributed to the developing techniques of percutaneous ablation. AIM: To determine the efficacy and safety of circumferential pulmonary vein ablation performed using the CARTO system in patients with paroxysmal or permanent AF. METHODS: The study involved 94 patients (mean age 54 years, males 65%, structural heart disease 29.4%) with symptomatic, recurrent and AF resistant to antiarrhythmic agents (paroxysmal AF 63.8%), selected for circumferential pulmonary vein ablation with the Pappone method. Follow-up examinations were performed after 1, 3, 6, 9, and 12 months. The symptoms, ECG, 24-hour ECG monitoring and complications were recorded. RESULTS: Mean procedure and fluoroscopy durations were 4.5 hours and 22.4 minutes respectively. The long-term follow-up ranged from 3 to 24 months, with median time of 12 months. At six months, 47.8% of patients remained free from AF, and improvement in terms of infrequent arrhythmia occurrence and low incidence of symptoms in an additional 36.7% was observed. Efficacy was lower in patients with permanent AF (12 months 90% vs 70%). Complications were seen in six (6.4%) patients: cardiac tamponade in two patients; and pericardial effusion, retroperitoneal bleeding, stroke, and pulmonary vein thrombosis each in one patient. CONCLUSIONS: Circumferential pulmonary vein ablation leads to resolution of arrhythmia or marked clinical improvement in about 75% of patients with symptomatic, resistant AF. The success rate is lower in patients with permanent rather than paroxysmal AF. As severe complications are not unlikely, the indications for such therapy must be carefully balanced.