3 Tesla MRI-detected brain lesions after pulmonary vein isolation for atrial fibrillation: results of the MACPAF study.
BACKGROUND
Left atrial catheter ablation (LACA) is an established therapeutic approach to abolish symptomatic atrial fibrillation (AF).


OBJECTIVE
Based on the prospective MACPAF study (clinicaltrials.gov NCT01061931) we report the rate of ischemic brain lesions postablation and their impact on cognitive function.


METHODS
Patients with symptomatic paroxysmal AF were randomized to LACA using the Arctic Front® or the HD Mesh Ablator® catheter. All patients underwent brain MRI at 3 Tesla, neurological, and neuropsychological examinations within 48 hours prior and after the ablation procedure.


RESULTS
There was no clinically evident stroke in 37 patients (mean age 62.4 ± 8.4 years; 41% female; median CHADS2 score 1 [IQR 0-2]) after LACA but high-resolution diffusion-weighted imaging (DWI) detected new ischemic lesions in 15 (41%) patients after LACA. Four (27%) of the HD Mesh Ablator® patients and 11 (50%) of the Arctic Front® patients suffered a silent ischemic lesion (P = 0.19). In these 15 patients, there was a nonsignificant trend toward lower cardiac ejection fraction (P = 0.07) and AF episodes during LACA (P = 0.09), while activated clotting time levels, number of energy applications, periprocedural electrocardioversion or CHADS(2) score had no impact. Lesion volumes varied from 5 to 150 mm(3) and 1 to 5 lesions were detected per patient. However, acute brain lesions had no effect on cognitive performance immediately after LACA. Of the DWI lesions postablation 82% were not detectable on FLAIR images 6-9 months postablation.


CONCLUSIONS
According to 3 Tesla high-resolution DWI, ischemic brain lesions after LACA were common but not associated with impaired cognitive function after the ablation procedure.
Department of Neurology, Charité-Universitätsmedizin Berlin, Germany. georg.haeusler@charite.de
Karl Georg
KG
Haeusler
Lydia
L
Koch
Juliane
J
Herm
Ute A
UA
Kopp
Peter U
PU
Heuschmann
Matthias
M
Endres
Heinz-Peter
HP
Schultheiss
Alexander
A
Schirdewan
Jochen B
JB
Fiebach
D000368:Aged; D001281:Atrial Fibrillation / Q000473:pathology / Q000601:surgery*; D002545:Brain Ischemia / Q000209:etiology* / Q000473:pathology; D017115:Catheter Ablation / Q000009:adverse effects*; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology; D011667:Pulmonary Veins / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome