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3 Tesla MRI-Detected Brain Lesions after Pulmonary Vein Isolation for Atrial Fibrillation: Results of the MACPAF Study.
MedLine Citation:
PMID:  22913568     Owner:  NLM     Status:  Publisher    
MRI 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 ( 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. (J Cardiovasc Electrophysiol, Vol. pp. 1-8).
Karl Georg Haeusler; Lydia Koch; Juliane Herm; Ute A Kopp; Peter U Heuschmann; Matthias Endres; Heinz-Peter Schultheiss; Alexander Schirdewan; Jochen B Fiebach
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-25
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  -     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-8-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2012 Wiley Periodicals, Inc.
Department of Neurology, Charité-Universitätsmedizin Berlin, Germany Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany Department of Cardiology and Pneumology, Charité-Universitätsmedizin Berlin, Germany Institute of Clinical Epidemiology and Biometry-Universität Würzburg, Germany Center for Clinical Studies, University Hospital Würzburg Comprehensive Heart Failure Center, University of Würzburg, Germany Excellence Cluster NeuroCure, Charité-Universitätsmedizin Berlin, Germany.
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