Fehmi Keçe

Chapter 5 120 5.4 Discussion/Conclusion In this study, a higher activation of an acute phasemarker (fibrinogen) andmore endothelial damage (a higher von Willebrand factor) and activation of fibrinolysis (increased D-dimer) were associated with MES with the PVAC-Gold catheter. These results suggest that in ablations with a stronger acute phase and endothelial damage response more micro- embolism occurs, which eventually results in a stronger activation of the fibrinolytic pathway with elevated D-dimer. During radiofrequency application with open-irrigated catheters, it has been shown that microparticles are especially seen in high energy ablations, drag ablations, and when high-temperature steam pops occur (3). The higher temperatures during ablation with non-irrigated catheters compared to temperature controlled irrigated catheters (3) may cause a stronger activation of the coagulation cascade (with a stronger acute phase response), and may thus result in an higher amount of silent cerebral embolism. Consequently, measuring coagulation markers in AF ablation may be helpful to identify patients with a high embolic burden to be referred for additional imaging to exclude cerebral infarcts. Currently, measuring D-dimer is proposed for the prediction of ischemic stroke in patients with AF during anticoagulation therapy (4). It may be useful to use this marker in patients undergoing AF ablation also. Larger studies are needed to explore the relationship between coagulation markers and MES in more depth and to define cut-off values for the prediction of silent cerebral ischemia during and after AF ablation.