What does this research mean for the field?

Ischemic brain lesions detected by 3 Tesla MRI are common after left atrial catheter ablation for atrial fibrillation, but they do not impair acute cognitive function and mostly resolve within 6 to 9 months. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the incidence of silent ischemic brain lesions identified by 3 Tesla MRI and assess their immediate impact on cognitive performance following catheter ablation for atrial fibrillation.

July 25, 2012Journal of Cardiovascular Electrophysiology

3 Tesla MRI‐Detected Brain Lesions after Pulmonary Vein Isolation for Atrial Fibrillation: Results of the MACPAF Study

View Full Paper

Ask AI

Bookmark

Why the study?

Does left atrial catheter ablation using different catheters affect the rate of ischemic brain lesions and cognitive function in patients with symptomatic paroxysmal atrial fibrillation?

Population

37 patients with symptomatic paroxysmal atrial fibrillation, mean age 62.4 ± 8.4 years, 41% female, median…

Comparison

Left atrial catheter ablation using the Arctic… vs Left atrial catheter ablation using the HD Mesh…

Design

RCT, randomized to LACA using the Arctic Front or the HD Mesh Ablator catheter

Follow-up

6-9 months

Authors

KHKarl Georg HæuslerElectrophysiology LKLydia KochUniversity of Veterinary Medicine Vienna JHJuliane HermHumboldt-Universität zu Berlin

Discussion

Member takes

Implication

Silent ischemic lesions after LACA lack acute cognitive effects; confirms short-term neurological safety but leaves open long-term risks.

Key Points

To evaluate the incidence of silent ischemic brain lesions identified by 3 Tesla MRI and assess their immediate impact on cognitive performance following catheter ablation for atrial fibrillation.
Randomized trial (MACPAF, NCT01061931) assigning patients with symptomatic paroxysmal atrial fibrillation to left atrial catheter ablation using either the Arctic Front® or HD Mesh Ablator® catheter.
A total of 37 patients (mean age 62.4 ± 8.4 years; 41% female; median CHADS2 score 1 [IQR 0–2]) underwent 3 Tesla brain MRI, neurological, and neuropsychological testing within 48 hours before and after ablation, with repeat FLAIR imaging at 6–9 months.
No clinically evident strokes occurred, but high-resolution diffusion-weighted imaging identified new acute ischemic lesions in 41% of patients (15/37), occurring in 27% (4/15) of HD Mesh Ablator® patients versus 50% (11/22) of Arctic Front® patients (P = 0.19).
Lesions numbered 1 to 5 per patient with volumes between 5 and 150 mm³, showing a nonsignificant trend toward lower ejection fraction (P = 0.07) and intraprocedural atrial fibrillation (P = 0.09), but no measurable effect on acute cognitive performance.
At 6 to 9 months postablation, 82% of the initial diffusion-weighted imaging lesions were no longer detectable on FLAIR sequences.

Structured PICO

Does left atrial catheter ablation using different catheters affect the rate of ischemic brain lesions and cognitive function in patients with symptomatic paroxysmal atrial fibrillation?

Population

37 patients with symptomatic paroxysmal atrial fibrillation, mean age 62.4 ± 8.4 years, 41% female, median CHADS2 score 1 [IQR 0-2].

Intervention

Left atrial catheter ablation (LACA) using the Arctic Front catheter

Comparator

Left atrial catheter ablation (LACA) using the HD Mesh Ablator catheter

Outcome

Rate of ischemic brain lesions postablation detected by 3 Tesla MRI and their impact on cognitive functionsafety

Silent ischemic brain lesions are common after left atrial catheter ablation for atrial fibrillation but are not associated with acute cognitive impairment.

Cite This Study

Hæusler et al. (2012) studied this question.

synapsesocial.com/papers/6a1be1aa01af05bf0da8fae0 https://doi.org/10.1111/j.1540-8167.2012.02420.x

Topics

Atrial fibrillation Persistent AF management AF ablation outcomes Anticoagulation in AF

View Full Paper

Ask AI

Bookmark