title: Neuropsychological effects of MRI-detected brain lesions after left atrial catheter ablation for atrial fibrillation: long-term results of the MACPAF study.
abstract: 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.
  
  
  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.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01061931.
authors.affiliation: Department of Neurology, Center for Stroke Research Berlin, Department of Cardiology and Pneumology, and Excellence Cluster NeuroCure, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Juliane
authors.initials: J
authors.lastname: Herm
authors.forename: Jochen B
authors.initials: JB
authors.lastname: Fiebach
authors.forename: Lydia
authors.initials: L
authors.lastname: Koch
authors.forename: Ute A
authors.initials: UA
authors.lastname: Kopp
authors.forename: Claudia
authors.initials: C
authors.lastname: Kunze
authors.forename: Christian
authors.initials: C
authors.lastname: Wollboldt
authors.forename: Peter
authors.initials: P
authors.lastname: Brunecker
authors.forename: Heinz-Peter
authors.initials: HP
authors.lastname: Schultheiss
authors.forename: Alexander
authors.initials: A
authors.lastname: Schirdewan
authors.forename: Matthias
authors.initials: M
authors.lastname: Endres
authors.forename: Karl Georg
authors.initials: KG
authors.lastname: Haeusler
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D002545:Brain Ischemia / Q000175:diagnosis* / Q000209:etiology*; D017115:Catheter Ablation / Q000009:adverse effects*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies
keywords: atrial fibrillation; catheter ablation; cognition; magnetic resonance imaging; stroke