Silent cerebral thromboembolism with left atrial ablation: a lurking danger.

摘要

While ablationists dread any complication, stroke and esophageal perforation are particularly feared, especially when treating nonlife-threatening arrhythmias such as atrial fibrillation.1 The reason for this is twofold. First, the sequelae from these events are often devastating. Second, we lack a clear understanding of how to prevent the complications. Often, it is unknown why they occur following one procedure and not following the many others performed in a similar manner. Stroke is uniquely troubling in that it is a known complication of the disease the ablation intends to "cure," and one nonrandomized observational study suggests ablation may reduce its occurrence during follow-up.2 Given the widespread appreciation of the devastation produced by stroke, patients are understandably most concerned about this possibility. Developing an understanding of the technical and pharamacologic interventions that mitigate stroke risk during ablation is paramount.In this issue of the Journal, Lickfett et al. report on the utility of diffusion-weighted magnetic resonance imaging (DW-MRI) as a tool to monitor embolic sequelae of catheter ablation for atrial fibrillation.3'4 Twenty patients who underwent a pulmonary vein isolation ablation procedure had DW-MRI performed. Half of the patients underwent postablation imaging alone, while the other half had both pre- and postablation imaging. The authors report three embolic events in 2 of 20 patients. Quite strikingly, no patient had overt clinical symptoms.