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3 Tesla MRI‐Detected Brain Lesions after Pulmonary Vein Isolation for Atrial Fibrillation: Results of the MACPAF Study
Author(s) -
HAEUSLER KARL GEORG,
KOCH LYDIA,
HERM JULIANE,
KOPP UTE A.,
HEUSCHMANN PETER U.,
ENDRES MATTHIAS,
SCHULTHEISS HEINZPETER,
SCHIRDEWAN ALEXANDER,
FIEBACH JOCHEN B.
Publication year - 2013
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2012.02420.x
Subject(s) - medicine , atrial fibrillation , lesion , catheter ablation , ablation , cardiology , pulmonary vein , fluid attenuated inversion recovery , radiology , nuclear medicine , magnetic resonance imaging , surgery
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 (clinicaltrials.gov 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. 24, pp. 14‐21, January 2013)