Why the study?
AF patients without other stroke risk factors are assumed to have a low annual stroke risk and are not recommended oral anticoagulation, prompting evaluation of clinically inapparent ischemic brain lesions via brain MRI in these patients.
Does the prevalence of silent ischemic brain lesions differ between AF patients without stroke risk factors and those with at least one stroke risk factor?
Does the prevalence of silent ischemic brain lesions differ between AF patients without stroke risk factors and those with at least one stroke risk factor?
Silent ischemic brain lesions are present in approximately 8% of symptomatic AF patients prior to ablation, with no significant difference in prevalence regardless of traditional stroke risk factors.
Silent lesions occur at similar rates in AF patients irrespective of stroke risk factors; leaves open whether brain imaging refines anticoagulation decisions in low-risk individuals.
BACKGROUND: Atrial fibrillation (AF) without other stroke risk factors is assumed to have a low annual stroke risk comparable to patients without AF. Therefore, current clinical guidelines do not recommend oral anticoagulation for stroke prevention of AF in patients without stroke risk factors. We analyzed brain magnetic resonance imaging (MRI) imaging to estimate the rate of clinically inapparent ("silent") ischemic brain lesions in these patients. METHODS: We pooled individual patient-level data from three prospective studies comprising stroke-free patients with symptomatic AF. All study patients underwent brain MRI within 24-48 h before planned left atrial catheter ablation. MRIs were analyzed by a neuroradiologist blinded to clinical data. RESULTS: -VASc = 1 (IQR 0-2), 33% persistent AF) were included. In AF patients without or with at least one stroke risk factor, at least one silent ischemic brain lesion was observed in 4 (8%) out of 48 and 10 (8%) out of 127 patients, respectively (p > 0.99). Presence of silent ischemic brain lesions was related to age (p = 0.03) but not to AF pattern (p = 0.77). At least one cerebral microbleed was detected in 5 (13%) out of 30 AF patients without stroke risk factors and 25 (25%) out of 108 AF patients with stroke risk factors (p = 0.2). Presence of cerebral microbleeds was related to male sex (p = 0.04) or peripheral artery occlusive disease (p = 0.03). CONCLUSION: In patients with symptomatic AF scheduled for ablation, brain MRI detected silent ischemic brain lesions in approximately one in 12 patients, and microbleeds in one in 5 patients. The prevalence of silent ischemic brain lesions did not differ in AF patients with or without further stroke risk factors.
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Herm et al. (2019) studied this question.
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