Transcranial Doppler Monitoring of the Wolf Procedure Versus Conventional Ablation to Treat Atrial Fibrillation

Background and Purpose: Transfemoral radiofrequency ablation (tfRFA) is the most performed procedure to address atrial fibrillation (AF); however, tfRFA produces thousands of microemboli that can reach major cerebral arteries and cause silent ischemic lesions. We measured the microembolization rate during an alternative procedure, the Wolf Procedure (formerly Mini-Maze), to address AF and compared our findings with the literature. Methods: We used transcranial Doppler monitoring on 10 patients with AF (seven permanent, three paroxysmal) who underwent the Wolf Procedure at Houston Methodist Hospital. Intraoperative emboli, mean flow velocity, and pulsatility index in the middle cerebral artery were monitored and recorded. Standard of care follow-up visits were done at Houston Methodist Hospital. During these visits, the patients’ loop recorder and current heart rhythm were analyzed. Results: Overall, we saw an average of 4.7 high-intensity transient signals (HITS) in our 10 patients with a median of 3 HITS (interquartile range = 1–5.25), which is markedly less than the thousands of HITS typically reported in the literature for cases that use tfRFA. In two of the 10 Wolf Procedure cases, zero microembolus was detected. At their last follow-up appointments, nine out of 10 patients were in sinus rhythm. Conclusion: The Wolf Procedure is a safe surgical option for AF treatment with a high success rate even after one procedure. The number of emboli during The Wolf Procedure appears to be markedly lower than that during tfRFA, which reduces patient risk for transient ischemic attack, stroke, and silent ischemic brain lesions.