title: A Patient With Asymptomatic Cerebral Lesions During AF Ablation: How Much Should We Worry?
abstract: Silent brain lesions due to thrombogenicity of the procedure represent recognized side effects of atrial fibrillation (AF) catheter ablation. Embolic risk is higher if anticoagulation is inadequate and recent studies suggest that uninterrupted anticoagulation, ACT levels above 300 seconds and administration of a pre-transeptal bolus of heparin might significantly reduce the incidence of silent cerebral ischemia (SCI) to 2%. Asymptomatic new lesions during AF ablation should suggest worse neuropsychological outcome as a result of the association between silent cerebral infarcts and increased long-term risk of dementia in non-ablated AF patients. However, the available data are discordant. To date, no study has definitely linked post-operative asymptomatic cerebral events to a decline in neuropsychological performance. Larger volumes of cerebral lesions have been associated with cognitive decline but are uncommon findings acutely in post-ablation AF patients. Of note, the majority of acute lesions have a small or medium size and often regress at a medium-term follow-up. Successful AF ablation has the potential to reduce the risk of larger SCI that may be considered as part of the natural course of AF. Although the long-term implications of SCI remain unclear, it is conceivable that strategies to reduce the risk of SCI may be beneficial.
authors.affiliation: Policlinico Tor Vergata, Rome, Italy.
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Forleo
authors.affiliation: Policlinico Tor Vergata, Rome, Italy.
authors.forename: Domenico G
authors.initials: DG
authors.lastname: Della Rocca
authors.affiliation: Policlinico Tor Vergata, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Lavalle
authors.affiliation: Policlinico Tor Vergata, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Mantica
authors.affiliation: Policlinico Tor Vergata, Rome, Italy.
authors.forename: Lida P
authors.initials: LP
authors.lastname: Papavasileiou
authors.affiliation: Policlinico Tor Vergata, Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Ribatti
authors.affiliation: Policlinico Tor Vergata, Rome, Italy.
authors.forename: Germana
authors.initials: G
authors.lastname: Panattoni
authors.affiliation: Policlinico Tor Vergata, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Santini
authors.affiliation: Policlinico Tor Vergata, Rome, Italy; Policlinico Tor Vergata, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.affiliation: Policlinico Tor Vergata, Rome, Italy; Policlinico Tor Vergata, Rome, Italy.
authors.forename: Luigi Di
authors.initials: LD
authors.lastname: Biase
keywords: Asymptomatic Cerebral Embolism; Atrial Fibrillation Ablation; Magnetic Resonance Imaging; Silent Cerebral Ischemia; Stroke