Detection of brain lesions after catheter ablation depends on imaging criteria: insights from AXAFA-AFNET 5 trial

Q: What are the key findings of this study?

High-resolution diffusion-weighted imaging detected at least one acute brain lesion in 26.2% of patients compared to 18.7% with standard imaging (P < 0.01) after atrial fibrillation ablation.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Symptomatic non-valvular atrial fibrillation (n=321). Intervention: High-resolution diffusion-weighted imaging (slice thickness 2.5-3 mm) vs. Standard diffusion-weighted imaging (slice thickness 5-6 mm). Primary outcome: Detection of at least one acute ischemic brain lesion (p=<0.01).

Q: What does this research mean for the field?

High-resolution diffusion-weighted imaging detects significantly more acute brain lesions following atrial fibrillation ablation compared to standard diffusion-weighted imaging. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Karl Georg Hæusler; Felizitas A. Eichner; Peter U. Heuschmann; Jochen B. Fiebach; Tobias Engelhorn; David J. Callans; Tom De Potter; Philippe Debruyne; Douglas S. Scherr; Gerhard Hindricks; Hussein R. Al‐Khalidi; Lluı́s Mont; Won Yong Kim; Jonathan P. Piccini; Ulrich Schotten; Sakis Themistoclakis; Luigi Di Biase; Paulus Kirchhof

doi:10.1093/europace/euad323

Key result

High-resolution DWI boosts detection of post-AF ablation acute brain lesions by ~40% vs standard imaging.

P<0.01
n=321

Figures

Graphical abstract published by EP Europace — Graphical abstract · Published by EP Europace · CC BY

Why the study?

Left atrial catheter ablation carries a risk of brain embolism, but the impact of diffusion-weighted imaging slice thickness on detecting post-ablation ischaemic brain lesions was unclear.

Does high-resolution diffusion-weighted imaging (hrDWI) improve the detection of acute ischaemic brain lesions compared to standard DWI in patients with symptomatic atrial fibrillation undergoing catheter ablation?

Study Design

Type

Cross-Sectional (n=321)

Blinding

Single-blind

Multicenter

Yes

Structured PICO

Does high-resolution diffusion-weighted imaging (hrDWI) improve the detection of acute ischaemic brain lesions compared to standard DWI in patients with symptomatic atrial fibrillation undergoing catheter ablation?

P

Population

321 patients (mean age 64 years, 33% female) with symptomatic non-valvular atrial fibrillation undergoing their first catheter ablation, evaluated with brain MRI 3-48 hours post-procedure.

I

Intervention

High-resolution diffusion-weighted imaging (hrDWI) with slice thickness 2.5-3 mm performed within 3-48 h after ablation

C

Comparator

Standard diffusion-weighted imaging (DWI) with slice thickness 5-6 mm performed within 3-48 h after ablation in the same patients

O

Outcome

Detection of at least one acute ischaemic brain lesionsurrogate

Main Result

Absolute Event Rate: 26.2% vs 18.7%

p-value: p=<0.01

High-resolution DWI significantly increases the detection rate of acute ischaemic brain lesions following left atrial catheter ablation compared to standard DWI.

Limitations

The brain MRI sub-study was not specifically powered to detect differences in brain lesions regarding DWI slice thickness or MRI field strength.
Only about half of the total trial cohort underwent brain MRI.
No MRI was performed immediately before ablation, so acute brain lesions occurring days prior cannot be definitively ruled out.
Patients were not examined at both 1.5 T and 3 T MRI field strengths.
The number of available slices differed between high-resolution and standard DWI data sets.
Unable to assess the impact of other technical MRI parameters like the number of active receiver channels or vendor-specific sequence parameters.
Brain MRI sub-study was not specifically powered to detect differences of brain lesions with regard to DWI slice thickness or MRI field strength
About half of the total AXAFA-AFNET 5 cohort underwent brain MRI
No MRI immediately before ablation, cannot rule out acute brain lesions within days before the ablation procedure
Study patients were not examined at both 1.5 and 3 T
Number of available slices differed in hrDWI and standard DWI data sets
Not able to assess the impact of other technical MRI parameters like number of active receiver channels in the head coil or vendor-specific sequence parameters

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Implication

hrDWI detects more acute brain lesions after AF ablation than standard DWI; leaves open whether additional lesions affect outcomes or management.

Abstract

AIMS: Left atrial catheter ablation is well established in patients with symptomatic atrial fibrillation (AF) but associated with risk of embolism to the brain. The present analysis aims to assess the impact of diffusion-weighted imaging (DWI) slice thickness on the rate of magnetic resonance imaging (MRI)-detected ischaemic brain lesions after ablation. METHODS AND RESULTS: AXAFA-AFNET 5 trial (NCT02227550) participants underwent MRI using high-resolution (hr) DWI (slice thickness: 2.5-3 mm) and standard DWI (slice thickness: 5-6 mm) within 3-48 h after ablation. In 321 patients with analysable brain MRI (mean age 64 years, 33% female, median CHA2DS2-VASc 2), hrDWI detected at least one acute brain lesion in 84 (26.2%) patients and standard DWI in 60 (18.7%; P < 0.01) patients. High-resolution diffusion-weighted imaging detected more lesions compared to standard DWI (165 vs. 104; P < 0.01). The degree of agreement for lesion confirmation using hrDWI vs. standard DWI was substantial (κ = 0769). Comparing the proportion of DWI-detected lesions, lesion distribution, and total lesion volume per patient, there was no difference in the cohort of participants undergoing MRI at 1.5 T (n = 52) vs. 3 T (n = 269). CONCLUSION: The pre-specified AXAFA-AFNET 5 sub-analysis revealed significantly increased rates of MRI-detected acute brain lesions using hrDWI instead of standard DWI in AF patients undergoing ablation. In comparison to DWI slice thickness, MRI field strength had a no significant impact in the trial. Comparing the varying rates of ablation-related MRI-detected brain lesions across previous studies has to consider these technical parameters. Future studies should use hrDWI, as feasibility was demonstrated in the multicentre AXAFA-AFNET 5 trial.

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Cite This Study

Hæusler et al. (2023) conducted a cross-sectional in Symptomatic non-valvular atrial fibrillation (n=321). High-resolution diffusion-weighted imaging (slice thickness 2.5-3 mm) vs. Standard diffusion-weighted imaging (slice thickness 5-6 mm) was evaluated on Detection of at least one acute ischemic brain lesion (p=<0.01). High-resolution diffusion-weighted imaging detected at least one acute brain lesion in 26.2% of patients compared to 18.7% with standard imaging (P < 0.01) after atrial fibrillation ablation.

synapsesocial.com/papers/6a1c105500ee29383e9d6565 https://doi.org/10.1093/europace/euad323

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Detection of brain lesions after catheter ablation depends on imaging criteria: insights from AXAFA-AFNET 5 trial

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Detection of brain lesions after catheter ablation depends on imaging criteria: insights from AXAFA-AFNET 5 trial

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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