title: Association between left atrial low-voltage area, serum apoptosis, and fibrosis biomarkers and incidence of silent cerebral events after catheter ablation of atrial fibrillation.
abstract: BACKGROUND
  Silent cerebral events (SCE) have been identified on cerebral diffusion-weighted cerebral magnetic resonance imaging (DE-MRI) after catheter ablation (CA) of atrial fibrillation (AF). The purpose of this study was to investigate the impact of atrial remodeling on the incidence of SCE after AF CA.
  
  
  METHODS
  Forty patients (67.8 ± 10 years, 47.5 % women) with symptomatic paroxysmal (n = 11, 27.5 %) or persistent AF undergoing AF CA were prospectively enrolled. LA fibrosis was estimated by intraprocedural bipolar voltage mapping in sinus rhythm. Apoptosis-stimulating fragment (Fas-Ligand) and amino terminal peptide from collagen III (PIIINP) concentrations were analyzed of LA and femoral vein blood. Cerebral DE-MRI was performed 1 to 2 days after CA of AF for detection of SCE. In nine patients (22.5 %), new SCE were detected on DE-MRI after AF CA.
  
  
  RESULTS
  Patients with SCE had higher CHA2DS2-VASc score, larger left atrial diameter (LADmax), and higher surface area of left atrial low-voltage (24 ± 11.2 vs 3.5 ± 4.2 %, p < 0.0001). Concentrations of peripheral PIIINP (103.7 ± 25.9 vs 81.8 ± 16.7 pg/ml, p < 0.01) and Fas-Ligand (124.1 ± 22.4 vs 87.6 ± 19.4 pg/ml, p < 0.01) were significantly higher in patients with SCE and correlated to low-voltage surface area (p < 0.01). Multivariable logistic regression analysis revealed peripheral Fas-Ligand, LADmax, CHA2DS2-Vasc score, and LA low-voltage area proportion to be independent predictors for the development of SCE.
  
  
  CONCLUSIONS
  LA remodeling, estimated by LADmax and LA low-voltage area, has significant relationship with the risk of SCE after AF ablation. Moreover, Fas-Ligand may act as an independent predictor for SCE in the context of AF CA.
authors.affiliation: Clinic for Interventional Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt an der Saale, 97616, Germany. Patrick.Mueller-3@ruhr-uni-bochum.de.|Cardiology & Angiology, Heart Center Bad Neustadt, Bad Neustadt an der Saale, Germany. Patrick.Mueller-3@ruhr-uni-bochum.de.
authors.forename: Patrick
authors.initials: P
authors.lastname: Müller
authors.affiliation: Cardiology & Angiology, Heart Center Bad Neustadt, Bad Neustadt an der Saale, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Maier
authors.affiliation: Endocrinology and Diabetes of the University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Johannes-Wolfgang
authors.initials: JW
authors.lastname: Dietrich
authors.affiliation: Clinic for Interventional Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt an der Saale, 97616, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Barth
authors.affiliation: Clinic for Interventional Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt an der Saale, 97616, Germany.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Griese
authors.affiliation: Cardiology & Angiology, Heart Center Bad Neustadt, Bad Neustadt an der Saale, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Schiedat
authors.affiliation: Clinic for Interventional Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt an der Saale, 97616, Germany.
authors.forename: Attila
authors.initials: A
authors.lastname: Szöllösi
authors.affiliation: Clinic for Interventional Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt an der Saale, 97616, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Halbfass
authors.affiliation: Clinic for Interventional Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt an der Saale, 97616, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Nentwich
authors.affiliation: Clinic for Interventional Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt an der Saale, 97616, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Roos
authors.affiliation: Clinic for Interventional Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt an der Saale, 97616, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Krug
authors.affiliation: Clinic for Interventional Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt an der Saale, 97616, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Schade
authors.affiliation: Radiology and the Divisions, Heart Center Bad Neustadt, Bad Neustadt an der Saale, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Schmitt
authors.affiliation: Cardiology & Angiology, Heart Center Bad Neustadt, Bad Neustadt an der Saale, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Mügge
authors.affiliation: Clinic for Interventional Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt an der Saale, 97616, Germany.|Cardiology & Angiology, Heart Center Bad Neustadt, Bad Neustadt an der Saale, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Deneke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017209:Apoptosis; D058070:Asymptomatic Diseases; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D001927:Brain Diseases / Q000097:blood / Q000175:diagnosis*; D017115:Catheter Ablation / Q000379:methods*; D038524:Diffusion Magnetic Resonance Imaging; D004452:Echocardiography; D053222:Fas Ligand Protein / Q000097:blood; D005260:Female; D005355:Fibrosis; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000097:blood; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis*; D011347:Procollagen / Q000097:blood; D011446:Prospective Studies; D011846:Radio Waves; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D053222:Fas Ligand Protein; D010446:Peptide Fragments; D011347:Procollagen; C041876:procollagen Type III-N-terminal peptide
keywords: Atrial fibrillation; Atrial fibrosis; Catheter ablation; Silent cerebral events; Thromboembolic risk