Silent cerebral events as a result of left atrial catheter ablation do not cause neuropsychological sequelae--a MRI-controlled multicenter study.
OBJECTIVE
Recently, diffusion-weighted magnetic resonance imaging (DW-MRI) revealed silent cerebral events (SCEs) as an acute complication of pulmonary vein isolation (PVI). We investigated whether SCEs following PVI are associated with neuropsychological deficits observed during patients' follow-up examinations.


METHODS
After PVI, 52 patients were eligible for follow-up. PVI was performed using a variety of ablation technologies (duty-cycled phased radiofrequency (RF) multipolar ablation with the Pulmonary Vein Ablation Catheter® (PVAC) in 24 patients, cooled-tip RF ablation in 23 patients, and cryoballoon ablation in five patients). Fluid-attenuated inversion recovery (FLAIR)- and DW-MRI studies were performed 1 day before PVI and 1 day and 1 month afterward to detect pre-existing cerebral lesions or post-ablation SCEs. At the same times, eight neuropsychological tests were administered. We evaluated changes in patients' neuropsychological capabilities and compared changes in patients with SCEs to those without SCEs.


RESULTS
FLAIR-MRI revealed pre-existing cerebral lesions in 42 patients (81 %), and DW-MRI demonstrated new SCEs in 25 patients (48 %) (17 treated with phased RF (PVAC) (71 %), six treated with irrigated RF (26 %), and two treated with cryoablation (40 %)). Neuropsychological test results showed no significant impairment (in median z scores) 1 day and 1 month after the ablation procedure. There was no difference in neuropsychological capabilities between patients with SCEs and those without SCEs except in one subtest (part of the verbal working memory test).


CONCLUSIONS
The incidence of pre-existing cerebral lesions and post-ablation SCEs was high. The frequency of SCEs depends on the ablation technology used. Neither PVI nor post-ablation SCEs have any effect on neuropsychological capabilities.
Department of Cardiology, Rotkreuzklinikum München, Akademisches Lehrkrankenhaus der TU München, Nymphenburgerstr 163, 80634, Munich, Germany, christian.vonbary@swmbrk.de.
Christian
C
von Bary
Thomas
T
Deneke
Thomas
T
Arentz
Anja
A
Schade
Heiko
H
Lehrmann
Christoph
C
Eissnert
Susanne
S
Schwab-Malek
Sabine
S
Fredersdorf
Ekrem
E
Ücer
Dobri
D
Baldaranov
Christina
C
Wendl
Felix
F
Schlachetzki
D058070:Asymptomatic Diseases; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D005858:Germany; D006325:Heart Atria / Q000601:surgery; D006329:Heart Conduction System / Q000601:surgery; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology* / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000209:etiology*; D009483:Neuropsychological Tests; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome