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@ARTICLE{Schreiber:282600,
      author       = {Schreiber, Tobias and von Rennenberg, Regina and Brämswig,
                      Tim Bastian and Landmesser, Ulf and Hindricks, Gerhard and
                      Nagel, Patrick and Tscholl, Verena and Huemer, Martin and
                      Lucas, Johannes and Attanasio, Philipp and Nolte, Christian
                      H},
      title        = {{C}omparison of {C}erebral {M}icro-{E}mbolization
                      {D}etected by {T}ranscranial {D}oppler {E}xamination
                      {B}etween {R}adiofrequency {A}blation and {P}ulsed {F}ield
                      {A}blation for {A}trial {F}ibrillation.},
      journal      = {Journal of cardiovascular electrophysiology},
      volume       = {36},
      number       = {12},
      issn         = {1045-3873},
      address      = {Oxford},
      publisher    = {Wiley-Blackwell},
      reportid     = {DZNE-2025-01358},
      pages        = {3288 - 3295},
      year         = {2025},
      abstract     = {Pulsed Field Ablation (PFA) can establish pulmonary vein
                      isolation via irreversible electroporation and is believed
                      to reduce overall complications; however, periprocedural
                      stroke has also been reported after PFA procedures.
                      Assessment of microembolic signals (MES) measured by
                      transcranial doppler (TCD) allows to monitor cerebral
                      embolization during the procedure and to identify higher
                      risk procedural steps. This study was designed to compare
                      the incidence of MES during different procedural steps
                      between two different PFA systems and radiofrequency
                      ablation (RFA).Pulmonary vein isolation was performed either
                      using either high-power short-duration radiofrequency
                      ablation (HPSD RFA), or PFA using a variable loop circular
                      catheter (VLCC) or a circular multielectrode array catheter
                      (CMAC). MES were compared during transseptal puncture,
                      ablation, left atrial mapping, and introduction/retraction
                      of catheters. Neurological examination was performed pre and
                      post ablation for all patients including the National
                      Institutes of Health Stroke Scale (NIHSS). Fifty-six
                      consecutive patients (19 female $(34\%),$ average age 70
                      years) were included: 28 in the HPSD RFA group and 14
                      patients each in the VLCC and CMAC groups. Total MES count
                      was higher for both PFA systems compared to HPSD RFA (VLCC
                      1402 (IQR 973), CMAC 449 (IQR 193) vs. HPSD RFA 131 (IQR
                      250); p < 0.001). MES count was higher in VLCC than in CMAC
                      (p < 0.001). In all groups, MES were most frequently
                      detected during ablation $(87\%$ of overall MES).
                      Postprocedural NIHSS did not differ between groups (median
                      NIHSS 0 [IQR 0] in all groups), yet two patients experienced
                      new focal neurological deficits after PFA.Pulsed field
                      ablation was associated with a higher cerebral MES count
                      than high-power short-duration radiofrequency ablation, with
                      marked differences between catheter systems. Transcranial
                      doppler indicates ablation as the most embolic step in both
                      PFA and high-power short duration ablation.},
      keywords     = {atrial fibrillation (Other) / microembolism (Other) /
                      pulsed field ablation (Other) / radiofrequency ablation
                      (Other)},
      cin          = {AG Endres},
      ddc          = {610},
      cid          = {I:(DE-2719)1811005},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41078013},
      doi          = {10.1111/jce.70140},
      url          = {https://pub.dzne.de/record/282600},
}