BACKGROUND: MRI-detected brain lesions are common after left atrial catheter ablation for symptomatic atrial fibrillation. The clinical relevance of these acute ischemic lesions is not fully understood, but ablation-related cerebral injury could contribute to cognitive dysfunction. METHODS AND RESULTS: In the prospective Mesh Ablator versus Cryoballoon Pulmonary Vein Ablation of Symptomatic Paroxysmal Atrial Fibrillation (MACPAF) study, serial 3-T brain MRIs and neuropsychological assessment were performed to analyze the rate of ablation-related brain lesions and their effect on cognitive function. Thirty-seven patients with paroxysmal atrial fibrillation (median age, 63.0 [interquartile range, 57-68] years; 41% female; median CHA2DS2VASc score 2 [interquartile range, 1-3]) underwent 41 ablation procedures according to study criteria. None of these patients had overt neurological deficits after ablation. High-resolution diffusion-weighted imaging, performed within 48 hours after ablation, showed that new brain lesions (range, 1-17) were present in 16 (43.2%) patients after 18 (43.9%) left atrial catheter ablation procedures. Follow-up MRI at 6 months (median, 6.5; interquartile range, 6-7) revealed that 7 (12.5%) of the 56 total acute brain lesions after ablation formed a persistent glial scar in 5 (31.3%) patients. Large diffusion-weighted imaging lesions and a corresponding fluid-attenuated inversion recovery lesion 48 hours after ablation predicted lesion persistence on 6-month follow-up. Neither persistent brain lesions nor the ablation procedure itself had a significant effect on attention or executive functions, short-term memory, or verbal and nonverbal learning after 6 months. CONCLUSIONS: Ablation-related acute ischemic brain lesions persist to some extent but do not cause cognitive impairment 6 months after the ablation procedure. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01061931.
BACKGROUND: MRI-detected brain lesions are common after left atrial catheter ablation for symptomatic atrial fibrillation. The clinical relevance of these acute ischemic lesions is not fully understood, but ablation-related cerebral injury could contribute to cognitive dysfunction. METHODS AND RESULTS: In the prospective Mesh Ablator versus Cryoballoon Pulmonary Vein Ablation of Symptomatic Paroxysmal Atrial Fibrillation (MACPAF) study, serial 3-T brain MRIs and neuropsychological assessment were performed to analyze the rate of ablation-related brain lesions and their effect on cognitive function. Thirty-seven patients with paroxysmal atrial fibrillation (median age, 63.0 [interquartile range, 57-68] years; 41% female; median CHA2DS2VASc score 2 [interquartile range, 1-3]) underwent 41 ablation procedures according to study criteria. None of these patients had overt neurological deficits after ablation. High-resolution diffusion-weighted imaging, performed within 48 hours after ablation, showed that new brain lesions (range, 1-17) were present in 16 (43.2%) patients after 18 (43.9%) left atrial catheter ablation procedures. Follow-up MRI at 6 months (median, 6.5; interquartile range, 6-7) revealed that 7 (12.5%) of the 56 total acute brain lesions after ablation formed a persistent glial scar in 5 (31.3%) patients. Large diffusion-weighted imaging lesions and a corresponding fluid-attenuated inversion recovery lesion 48 hours after ablation predicted lesion persistence on 6-month follow-up. Neither persistent brain lesions nor the ablation procedure itself had a significant effect on attention or executive functions, short-term memory, or verbal and nonverbal learning after 6 months. CONCLUSIONS: Ablation-related acute ischemic brain lesions persist to some extent but do not cause cognitive impairment 6 months after the ablation procedure. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01061931.
Entities:
Keywords:
atrial fibrillation; catheter ablation; cognition; magnetic resonance imaging; stroke
Authors: S Kochhäuser; H H Lohmann; M A Ritter; P Leitz; F Güner; S Zellerhoff; C Korsukewitz; D G Dechering; J Banken; N M Peters; L Eckardt; G Mönnig Journal: Clin Res Cardiol Date: 2014-10-22 Impact factor: 5.460
Authors: Kevin G Graves; Victoria Jacobs; Heidi T May; Michael J Cutler; John D Day; T Jared Bunch Journal: Curr Treat Options Cardiovasc Med Date: 2018-01-24
Authors: Michael L Alosco; Mary Beth Spitznagel; Lawrence H Sweet; Richard Josephson; Joel Hughes; John Gunstad Journal: Pacing Clin Electrophysiol Date: 2014-12-10 Impact factor: 1.976
Authors: Tina Lin; Erik Wissner; Roland Tilz; Andreas Rillig; Shibu Mathew; Peter Rausch; Peter Rausch; Christine Lemes; Sebastian Deiss; Masashi Kamioka; Tudor Bucur; Feifan Ouyang; Karl-Heinz Kuck; Andreas Metzner Journal: J Atr Fibrillation Date: 2014-06-30
Authors: Alexander Schirdewan; Juliane Herm; Mattias Roser; Ulf Landmesser; Matthias Endres; Lydia Koch; Karl Georg Haeusler Journal: Front Cardiovasc Med Date: 2017-02-13
Authors: Nikolaos Dagres; Tze-Fan Chao; Guilherme Fenelon; Luis Aguinaga; Daniel Benhayon; Emelia J Benjamin; T Jared Bunch; Lin Yee Chen; Shih-Ann Chen; Francisco Darrieux; Angelo de Paola; Laurent Fauchier; Andreas Goette; Jonathan Kalman; Lalit Kalra; Young-Hoon Kim; Deirdre A Lane; Gregory Y H Lip; Steven A Lubitz; Manlio F Márquez; Tatjana Potpara; Domingo Luis Pozzer; Jeremy N Ruskin; Irina Savelieva; Wee Siong Teo; Hung-Fat Tse; Atul Verma; Shu Zhang; Mina K Chung; William-Fernando Bautista-Vargas; Chern-En Chiang; Alejandro Cuesta; Gheorghe-Andrei Dan; David S Frankel; Yutao Guo; Robert Hatala; Young Soo Lee; Yuji Murakawa; Cara N Pellegrini; Claudio Pinho; David J Milan; Daniel P Morin; Elenir Nadalin; George Ntaios; Mukund A Prabhu; Marco Proietti; Lena Rivard; Mariana Valentino; Alena Shantsila Journal: J Arrhythm Date: 2018-03-23
Authors: Hannes Nordmeyer; René Chapot; Ayhan Aycil; Christian P Stracke; Marta Wallocha; M Jeffrie Hadisurya; Markus Heddier; Patrick Haage; Ralph Weber Journal: Front Neurol Date: 2018-07-09 Impact factor: 4.003