AF ablation associated with increased short-term risk of silent strokes

If they're silent, how do you know if you had one? Effect many be cumulative

[www.jafib.com]

This is a known issue,

But in this study pf 234 people with 33 temporary embolism and only 1 TIA was reporeted in 2010 and I dont know what center(s) and ablationist they tabulated the data from?

No respectable ablationist now would find an ACT ( activated clotting time) of <250 acceptable and it was ablations using at or below 250 in which these 'silent strokes' were noted. Also, these kind of silent strokes are more common when using non-irrigated catheters which is increasing rare to find these days as well.

For instance for many years Natale's groups have standardized on doing ablations only with a tightly controlled ACT of >350 that has to be at that level BEFORE transeptal puncture which is a key step in their extremely low stroke risk numbers.

These steps dramatically cut down on any chance of such silent embolic events and they use only the latest irrigated catheters as well when you chose a top quality ablationist and center. So two good questions to ask your EP prior to ablation is .. do you adjust to maintain an ACT of 350 or greater just prior to and continuing until all catheter sheaths are withdraw and do you use irrigated water cooled catheters to reduce the chance of excess temperature with its enhanced possibility of char formation.

Also, those that use real time intracardiac-echocardiography (or ICE) imaging as well have another value weapon for reducing any stroke embolism issues by being able to directly visualize any possible micro-bubble formation in the blood inside the left atrium due to temporary overheating of the catheter and can then immediately reduce temperature to a safe level. They can also often visualize if there are any 'bubbles' formed on the penetration tips of the catheter immediately post transeptal puncture and then remove it before it could possible shake loose and cause an issue.

In any event, this article raises valid concerns but it mostly looking backward compared to current state of the art since instituted by leading ablationist's to reduce any such possibilities to a minimum. And yet, the message here also underscores all the more, my central mantra recommendation to all people when first considering an ablation. That is, to do anything and everything you possibly can to insure you have a truly top elite-level ablationist with the greatest amount of experience and track record as you can possibly arrange. That is your very best defense against the vast majority of possible unwanted complications from any ablation, including this silent stroke issue which will be vanishingly less common now with the top EPs than was found in this small 2010 study.

Shannon



Edited 1 time(s). Last edit at 11/10/2012 12:11AM by Shannon.

Shannon,
Without an MRI of the brain there no no way in knowing if you have silent strokes. No top elite ablationist gives an MRI after a procedure so how do we really know?
I had 2 tiny ones that were old and I knew nothing about until my recent one which they diagnosed with an MRI. Time to take my Xarelto now.

afhound99 Wrote:
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> If they're silent, how do you know if you had one?
> Effect many be cumulative
>
> [www.jafib.com]

You don't without an MRI