Neurologische Komplikationen nach linksatrialer Katheterablation bei Vorhofflimmern

K. G. Häusler; U. Tebbe; S. Willems; C. Sprenger; P. Kirchhof; M. Endres; M. Oeff

doi:10.1055/s-0038-1628229

Nervenheilkunde, Table of Contents

Nervenheilkunde 2012; 31(11): 830-835
DOI: 10.1055/s-0038-1628229

Kompetenzentz Vorhofflimmern

Schattauer GmbH

Neurologische Komplikationen nach linksatrialer Katheterablation bei Vorhofflimmern

Neurological complications after left atrial catheter ablation for atrial fibrillation

K. G. Häusler

¹Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin

²Centrum für Schlaganfall -forschung Berlin

³Kompetenznetz Vorhofflimmern (AFNET)

,

U. Tebbe

³Kompetenznetz Vorhofflimmern (AFNET)

⁴Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin Klinikum Lippe GmbH, Detmold

,

S. Willems

³Kompetenznetz Vorhofflimmern (AFNET)

⁵Klinik für Kardiologie und Angiologie, Universitätsklinikum Hamburg

,

C. Sprenger

³Kompetenznetz Vorhofflimmern (AFNET)

⁶Klinik für Innere Medizin I, Städtisches Klinikum Brandenburg

,

P. Kirchhof

³Kompetenznetz Vorhofflimmern (AFNET)

⁷University of Birmingham Centre for Cardiovascular Sciences City Hospital Birmingham, UK und Department für Kardiologie und Angiologie, Universitätsklinikum Münster

,

M. Endres

¹Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin

²Centrum für Schlaganfall -forschung Berlin

⁸Exzellenzcluster NeuroCure, Charité – Universitätsmedizin Berlin

,

M. Oeff

³Kompetenznetz Vorhofflimmern (AFNET)

⁶Klinik für Innere Medizin I, Städtisches Klinikum Brandenburg

› Author Affiliations

Abstract

Zusammenfassung

Die linksatriale Katheterablation hat sich als therapeutische Option bei symptomatischem paroxysmalem oder persistierendem Vorhofflimmern (VHF) etabliert. Bei der Mehrheit der Patienten kann nach teils mehrfachen Ablationen eine suffiziente Symptomkontrolle erreicht werden. In vielen Fällen kann ein langfristiger Erhalt des Sinusrhythmus erzielt werden, was für die Vermeidung von VHF-assoziierten Komplikationen von Bedeutung sein könnte. Diese Arbeit gibt einen Überblick über mögliche neurologische Komplikationen der linksatrialen Katheterablation. Neurologische Komplikation treten nach linksatrialer Katheterablation bei 0,4 bis 1,2% der Patienten auf und werden vorwiegend durch akute zerebrale Ischämien bedingt. Nicht ischämisch bedingte neurologische Komplikationen sind sehr selten und werden hauptsächlich durch Phrenikusläsionen hervorgerufen. Zudem geht die sporadisch periinterventionell induzierte atrio-ösophageale Fistel in der Mehrzahl der beschriebenen Fälle mit neurologischen Komplikationen einher. In Abhängigkeit vom eingesetzten Ablationssystem können bei Patienten ohne fokal neurologisches Defizit postinterventionell in variierender Häufigkeit akute zerebrale Läsionen nachgewiesen werden. Die klinische Bedeutung dieser mittels MRT detektierten zerebralen Ischämien kann noch nicht beurteilt werden.

Summary

Left atrial catheter ablation has become an established therapy to abolish symptomatic paroxysmal and persistent atrial fibrillation. Most patients undergoing (several) catheter ablation procedures have sufficient symptom relief. In addition, restoring sinus rhythm may help to prevent AF-related complications on the long-term. This review summarizes the current knowledge regarding ablation-related neurological complications. Neurological complications occur in 0.4 to 1.2% of all patients undergoing ablation and are predominantly caused by cerebral ischemia. Nonischemic neurological complications are rare and are generally caused by phrenic nerve paralysis. In addition, neurological complications frequently occur after atrio-oesophageal fistula, a rather seldom complication of left atrial catheter ablation. Moreover, MRI-detected brain lesions without corresponding neurological symptoms can be common after catheter ablation procedures, and may depend on the ablation technology employed. However, the clinical relevance of these ischemic brain lesions is not totally understood so far.

Schlüsselwörter

Vorhofflimmern - Katheterablation - Schlaganfall - Komplikationen

Keywords

Atrial fibrillation - catheter ablation - stroke - complications

Full Text

References

Literatur
1 Allen SJ, Sidebotham DA. Seizures and shock after radiofrequency ablation for atrial fibrillation. J Cardiothorac Vasc Anesth 2010; 24 (04) 716-8.
2 Anfinsen OG. et al. When should heparin preferably be administered during radiofrequency catheter ablation?. Pacing Clin Electrophysiol 2001; 24: 5-12.
3 Bahnson TD. Strategies to minimize the risk of esophageal injury during catheter ablation for atrial fibrillation. Pacing Clin Electrophysiol 2009; 32 (02) 248-60.
4 Bertaglia E. et al. Early complications of pulmonary vein catheter ablation for atrial fibrillation: a multi-center prospective registry on procedural safety. Heart Rhythm 2007; 4: 1265-71.
5 Blanc JJ. et al. Consensus document on antithrombotic therapy in the setting of electrophysiological procedures. Europace 2008; 10: 513-27.
6 Brott T. et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989; 20: 864-70.
7 Bruckenberger E. Elektrophysiologische Untersuchungen und Ablationen 2010. Herzbericht 2010; 51.
8 Bunch TJ. et al. Atrial fibrillation is independently associated with senile, vascular, and Alzheimer’s dementia. Heart Rhythm 2010; 7: 433-7.
9 Bunch TJ. et al. Patients treated with catheter ablation for atrial fibrillation have long-term rates of death, stroke, and dementia similar to patients without atrial fibrillation. J Cardiovasc Electrophysiol 2011; 22: 839-45.
10 Büsing KA. et al. Cerebral infarction: incidence and risk factors after diagnostic and interventional cardiac catheterization--prospective evaluation at diffusion-weighted MR imaging. Radiology 2005; 235 (01) 177-83.
11 Camm AJ. et al. Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010; 31: 2369-429.
12 Camm AJ. et al. Real-Life observations of clinical outcomes with rhythm- and rate-control therapies for atrial fibrillation RECORD AF. J Am Coll Cardiol 2011; 58 (05) 493-501.
13 Cappato R. et al. Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation. J Am Coll Cardiol 2009; 53 (19) 1798-803.
14 Cappato R. et al. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electro-physiol 2010; 3: 32-8.
15 Calkins H. et al. HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2007; 4: 816-61.
16 Dagres N. et al. Complications of atrial fibrillation ablation in a high-volume center in 1,000 procedures: still cause for concern?. J Cardiovasc Electrophysiol 2009; 20: 1014-9.
17 Debette S, Markus HS. The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ 2010; 341: c3666.
18 Deneke T. et al. Postablation asymptomatic cerebral lesions: long-term follow-up using magnetic resonance imaging. Heart Rhythm 2011; 8 (11) 1705-11.
19 Di Biase L. et al. Periprocedural stroke and management of major bleeding complications in patients undergoing catheter ablation of atrial fibrillation. Circulation 2010; 121: 2550-6.
20 Dorenbeck U. et al. Cerebral embolism with interventional closure of symptomatic patent foramen ovale: an MRI-based study using diffusion-weighted imaging. Eur J Neurol 2007; 14 (04) 451-4.
21 Gaita F. et al. Radiofrequency catheter ablation of atrial fibrillation: a cause of silent thromboembolism?. Circulation 2010; 122: 1667-73.
22 Gaita F. et al. Incidence of silent cerebral thromboembolic lesions after atrial fibrillation ablation may change according to technology used. J Cardiovasc Electrophysiol 2011; 22 (09) 961-8.
23 Gibson DN. et al. Stiff left atrial syndrome following catheter ablation for atrial fibrillation. Heart Rhythm 2011; 8 (09) 1364-71.
24 Guiot A. et al. Collateral nervous damages after cryoballoon pulmonary vein Isolation. J Cardiovasc Electrophysiol. 2011 Online 14.11.
25 Haissaguerre M. et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998; 339: 659-66.
26 Häusler KG. et al. Stroke risk associated with balloon based catheter ablation for atrial fibrillation: Rationale and design of the MACPAF Study. BMC Neurol 2010; 10: 63.
27 Häusler KG, Kirchhof P, Endres M. Left atrial catheter ablation and ischemic stroke. Stroke 2012; 43 (01) 265-70.
28 Häusler KG, Breithardt G, Endres M. Schlaganfallprävention bei Vorhofflimmern – Ein Update. Nervenheilkunde 2012; 31: 409-418.
29 Herrera Siklódy C. et al. Incidence of asymptomatic intracranial embolic events after pulmonary vein isolation comparison of different atrial fibrillation ablation technologies in a multicenter study. J Am Coll Cardiol 2011; 58: 681-8.
30 Hinkle DA. et al. Cerebral air embolism complicating cardiac ablation procedures. Neurology 2001; 56: 792-4.
31 Hoyt H. et al. Complications arising from catheter ablation of atrial fibrillation: temporal trends and predictors. Heart Rhythm 2011; 8 (12) 1869-74.
32 Hunter RJ, Schilling RJ. Long-term outcome after catheter ablation for atrial fibrillation: safety, efficacy and impact on prognosis. Heart 2010; 96: 1259-63.
33 Hussein AA. et al. Radiofrequency ablation of atrial fibrillation under therapeutic international normalized ratio: a safe and efficacious periprocedural anticoagulation strategy. Heart Rhythm 2009; 6: 1425-9.
34 Kahlert P. et al. Silent and apparent cerebral ischemia after percutaneous transfemoral aortic valve implantation: a diffusion-weighted magnetic resonance imaging study. Circulation 2010; 121 (07) 870-8.
35 Kim IC. et al. Incidence and predictors of silent embolic cerebral infarction following diagnostic coronary angiography. Int J Cardiol 2011; 148: 179-82.
36 Kirchhof P. Can we improve outcomes in AF patients by early therapy?. BMC Med 2009; 7: 72.
37 Meinertz T. et al. Antiarrhythmische Pharmakotherapie. Nervenheilkunde 2012; 31: 826-9.
38 Kok LC. et al. Cerebrovascular complication associated with pulmonary vein ablation. J Cardiovasc Electrophysiol 2002; 13: 764-7.
39 Kottkamp H. et al. Deep sedation for catheter ablation of atrial fibrillation: a prospective study in 650 consecutive patients. J Cardiovasc Electrophysiol 2011; 22 (12) 1339-43.
40 Lakkireddy D. et al. Feasibility and safety of dabigatran versus warfarin for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation results from a multi-center prospective registry. J Am Coll Cardiol. 2012 Jan 24; E-pub ahead of print.
41 Leary MC, Caplan LR. Technology insight: brain MRI and cardiac surgery – detection of postoperative brain ischemia. Nat Clin Pract Cardiovasc Med 2007; 4 (07) 379-88.
42 Lickfett L. et al. Cerebral diffusion-weighted magnetic resonance imaging: a tool to monitor the thrombogenicity of left atrial catheter ablation. J Cardiovasc Electrophysiol 2006; 17 (01) 1-7.
43 Maleki K. et al. Intracardiac ultrasound detection of thrombus on transseptal sheath: incidence, treatment, and prevention. J Cardiovasc Electrophysiol 2005; 16: 561-5.
44 Neumann T. et al. MEDAFI-Trial: comparison of pulmonary vein isolation using cryoballoon technique vs. radiofrequency energy. Europace 2011; 13: 37-44.
45 Ouyang F. et al. Long-term results of catheter ablation in paroxysmal atrial fibrillation: lessons from a 5-year follow-up. Circulation 2010; 122: 2368-77.
46 Patel D. et al. Long-term functional and neurocognitive recovery in patients who had an acute cerebrovascular event secondary to catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2010; 21: 412-7.
47 Pürerfellner H, Stöllberger C, Finsterer J. Meningoencephalitis as initial manifestation of a fatal atriooesophageal fistula after atrial fibrillation ablation. Acta Cardiol 2011; 66 (04) 555-7.
48 Ren JF, Marchlinski FE, Callans DJ. Left atrial thrombus associated with ablation for atrial fibrillation: identification with intracardiac echocardiography. J Am Coll Cardiol 2004; 43: 1861-7.
49 Sacher F. et al. Phrenic nerve injury after atrial fibrillation catheter ablation: characterization and outcome in a multicenter study. J Am Coll Cardiol 2006; 47 (12) 2498-503.
50 Salukhe TV. et al. Propofol sedation administered by cardiologists without assisted ventilation for long cardiac interventions: an assessment of 1000 consecutive patients undergoing atrial fibrillation ablation. Europace. 2011 Online 23.10.
51 Scherr D. et al. Incidence and predictors of periprocedural cerebrovascular accident in patients undergoing catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2009; 20: 1357-63.
52 Schrickel JW. et al. Incidence and predictors of silent cerebral embolism during pulmonary vein catheter ablation for atrial fibrillation. Europace 2010; 12: 52-7.
53 Schwarz N. et al. Neuropsychological decline after catheter ablation of atrial fibrillation. Heart Rhythm 2010; 7: 1761-7.
54 Spragg DD. et al. Complications of catheter ablation for atrial fibrillation: incidence and predictors. J Cardiovasc Electrophysiol 2008; 19: 627-31.
55 Stöllberger C, Pulgram T, Finsterer J. Neurological consequences of atrioesophageal fistula after radio-frequency ablation in atrial fibrillation. Arch Neurol 2009; 66 (07) 884-7.
56 Thrall G. et al. Quality of life in patients with atrial fibrillation: a systematic review. Am J Med 2006; 119: 448e1-e19.
57 Van Belle Y. et al. One year follow-up after cryobal-loon isolation of the pulmonary veins in patients with paroxysmal atrial fibrillation. Europace 2008; 10 (11) 1271-6.
58 Van Gelder IC. et al. Rationale and current perspective for early rhythm control therapy in atrial fibrillation. Europace 2011; 13 (11) 1517-25.
59 Wann LS. et al. 2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (updating the 2006 guideline). Circulation 2011; 123: 104-23.
60 Wazni O, Wilkoff B, Saliba W. Catheter ablation for atrial fibrillation. N Engl J Med 2011; 365 (24) 2296-304.
61 Weerasooriya R. et al. Catheter ablation for atrial fibrillation: are results maintained at 5 years of follow-up?. J Am Coll Cardiol 2011; 57: 160-6.
62 Wilber DJ. et al. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. JAMA 2010; 303: 333-40.