Key result
Transcatheter AF ablation is associated with a ~17% incidence of new, small cerebral ischemic lesions.
Why the study?
Recognizing etiology is essential for treatment and secondary prevention of cerebral ischemic events, but uniformly accepted MRI criteria for embolic etiology remain lacking.
Meta-Analysis (n=3,304)
Following atrial fibrillation ablation, 17.2% of patients develop new cerebral ischemic lesions on MRI, though only 0.6% are symptomatic, typically presenting as small cortical lesions in the middle cerebral artery territory.
Answers are grounded in this paper and cite their sources.
Silent lesions complicate most AF ablations; extends incidence data but leaves open long-term cognitive impact.
Background: Recognizing etiology is essential for treatment and secondary prevention of cerebral ischemic events. A magnetic resonance imaging (MRI) pattern suggestive of an embolic etiology has been described but, to date, there are no uniformly accepted criteria. Aim: The purpose of the study is to describe MRI features of ischemic cerebral lesions occurring after transcatheter ablation of atrial fibrillation (AF). Methods: A systematic review and meta-analysis of studies performing brain imaging investigations before and after AF transcatheter ablation was performed. The incidence of cerebral ischemic lesions after AF transcatheter ablation was the primary endpoint. The co-primary endpoints were the prevalence of the different neuroimaging features regarding the embolic cerebral ischemic lesions. Results: A total of 25 studies, encompassing 3,304 patients, were included in the final analysis. The incidence of ischemic cerebral lesions following AF transcatheter ablation was 17.2% [95% confidence interval (CI) 12.2%-23.8%], of which a minimal fraction was symptomatic [0.60% (95% CI 0.09%-3.9%)]. Only 1.6% of the lesions (95% CI 0.9%-3.0%) had a diameter >10 mm, and in 20.5% of the cases the lesions were multiple (95% CI 17.1%-24.4%). Brain lesions were equally distributed across the two hemispheres and the different lobes; cortical location was more frequent [64.0% (95% CI 42.9%-80.8%)] while the middle cerebral artery territory was the most involved 37.0% (95% CI 27.3-48.0). Conclusions: The prevailing MRI pattern comprises a predominance of small (<10 mm) cortical lesions, more prevalent in the territory of the middle cerebral artery.
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Saglietto et al. (2024) conducted a meta-analysis in Atrial fibrillation (n=3,304). Transcatheter ablation of atrial fibrillation was evaluated on Incidence of new cerebral ischemic lesions (95% CI 12.2%-23.8%). Transcatheter ablation of atrial fibrillation was associated with a 17.2% incidence of new cerebral ischemic lesions, which were predominantly small (<10 mm) and located in the cerebral cortex.
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