{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T18:47:15Z","timestamp":1768589235860,"version":"3.49.0"},"reference-count":31,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2017,10,16]],"date-time":"2017-10-16T00:00:00Z","timestamp":1508112000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Ultrasound Medicine"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Microembolic signal detection by transcranial Doppler ultrasonography may be considered a surrogate for cerebral events during invasive cardiac procedures. However, the impact of the microembolic signal count during pulmonary vein isolation on the clinical outcome is not well evaluated. We investigated the effect of the microembolic signal count on the occurrence of new silent cerebral embolism measured by diffusion\u2010weighted imaging (DWI)\u2010magnetic resonance imaging (MRI), changes in neuropsychological testing, and the occurrence of clinical events during long\u2010term follow\u2010up after pulmonary vein isolation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Pulmonary vein isolation was performed in 41 patients. The total microembolic signal burden (classified into \u201csolid,\u201d \u201cgaseous,\u201d and \u201cequivocal\u201d) and sustained thromboembolic showers of greater than 30 seconds were recorded. Diffusion\u2010weighted imaging\u2010MRI and neuropsychological testing were performed before and after pulmonary vein isolation to assess for silent cerebral embolism and neuropsychological sequelae. Long\u2010term follow\u2010up was performed by telephone to assess for stroke\/transient ischemic attack.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 68,729 microembolic signals (14,893 solid, 11,909 gaseous, and 41,927 equivocal) with an average of 1676 signals per patient and 42 thromboembolic showers were recorded. No correlation between the microembolic signal\/thromboembolic shower count and the occurrence of new DWI lesions or neuropsychological capability was found. After a mean follow\u2010up\u2009\u00b1\u2009SD of 49\u2009\u00b1\u20094 months, 1 patient had an overt transient ischemic event, which was not associated with a high microembolic signal count.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this multicenter study, we found no impact of the intraprocedural microembolic symbol\/thromboembolic shower count on the occurrence of new DWI lesions, neuropsychological capability, or overt neurologic deficits after pulmonary vein isolation. Thus, not only the microembolic signal count but also procedural\/individual factors may contribute to commensurable clinical damage, which may challenge this method as a valid biomarker during pulmonary vein isolation.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jum.14447","type":"journal-article","created":{"date-parts":[[2017,10,16]],"date-time":"2017-10-16T08:51:40Z","timestamp":1508143900000},"page":"1091-1101","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Clinical Impact of the Microembolic Signal Burden During Catheter Ablation for Atrial Fibrillation: Just a Lot of Noise?"],"prefix":"10.1002","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0008-0541","authenticated-orcid":false,"given":"Christian","family":"von Bary","sequence":"first","affiliation":[{"name":"Department of Cardiology Rotkreuzklinikum M\u00fcnchen Munich Germany"},{"name":"Department of Internal Medicine II University of Regensburg Regensburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Deneke","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology Heart Center Bad Neustadt Bad Neustadt Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Arentz","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology Heart Center Bad Krozingen Bad Krozingen Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anja","family":"Schade","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology Heart Center Bad Neustadt Bad Neustadt Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heiko","family":"Lehrmann","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology Heart Center Bad Krozingen Bad Krozingen 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