Brain magnetic resonance imaging and cognitive alterations after ablation in patients with atrial fibrillation

Abstract

Catheter ablation is an important non-pharmacological intervention for atrial fibrillation (AF), but its effect on the incidence of asymptomatic cerebral emboli and long-term effects on cognitive function remain unknown. We prospectively enrolled 101 patients who underwent AF ablation. Brain magnetic resonance imaging (MRI) (72 patients) and neuropsychological assessments (66 patients) were performed 1–3 days (baseline) and 6 months after ablation. Immediately after ablation, diffusion-weighted MRI and 3-dimensional double inversion recovery (3D-DIR) detected embolic microinfarctions in 63 patients (87.5%) and 62 patients (86.1%), respectively. After 6 months, DIR lesions disappeared in 41 patients. Microbleeds (MBs) increased by 17%, and 65% of the de novo MBs were exactly at the same location as the microinfarctions. Average Mini-Mental State Examination scores improved from 27.9 ± 2.4 to 28.5 ± 1.7 (p = 0.037), and detailed neuropsychological assessment scores showed improvement in memory, constructional, and frontal lobe functions. Ejection fraction, left atrial volume index and brain natriuretic peptide level improved from baseline to 3–6 months after ablation. Despite incidental microemboli, cognitive function was preserved 6 months after ablation.

Impact of Catheter Ablation on Brain Microstructure and Blood Flow Alterations for Cognitive Improvements in Patients with Atrial Fibrillation: A Pilot Longitudinal Study

“…Jin and colleagues [ 4 ] reported a significant improvement in cognitive function (assessed using the Montreal Cognitive Assessment) in an AF ablation group at 3 months and 1 year after the intervention, with the cognitive improvement being more pronounced among those patients with a mild cognitive impairment at baseline. More recently, a prospective study enrolled 74 Japanese patients who underwent AF ablation and reported that scores for the MMSE, immediate recall, delayed recall, constructional visuospatial ability, and TMT were significantly improved 6 months after ablation therapy [ 7 ]. However, contrary to such reports suggesting long-term protective effects on cognitive function, Kochhauser et al [ 12 ] found no significant cognitive change associated with AF ablation.…”

“…Catheter ablation therapy is an option for the surgical cure of AF, and patients with AF can achieve complete rhythmic control through this procedure. Although emerging research suggests that catheter ablation might mitigate cognitive decline, reduce the risk of AD, and improve cognitive function [ 4 , 7 , 8 ], the exact neural basis through which ablation therapy may exert such effects has not been well investigated.…”

Cerebral Microbleeds With Atrial Fibrillation After Ablation Therapy

“…All patients were recruited from the Department of Cardiology, Mie University Hospital between August 2017 and September 2018. We recruited 101 patients who were admitted to the hospital for AF catheter ablation ( Kato et al, 2021 ).…”

“…MRI studies were performed at 1–3 days (baseline) and 6 months after ablation (follow-up) with a 3T MR unit (Ingenia, Philips Medical System, The Netherlands) using a 32-channel phased-array head coil ( Kato et al, 2021 ). We used diffusion-weighted imaging (DWI), three-dimensional (3D) fluid-attenuated inversion recovery (3D-FLAIR), 3D double inversion recovery (3D-DIR), and 3D T1-weighted imaging (3D-T1WI) to detect microemboli ( Ii et al, 2013 , 2019 ).…”

“…The underlying pathophysiology of strictly lobar CMBs in patients with AF is yet to be ascertained (Selim and Diener, 2017). In a previous study, we have reported alleviation of cognitive dysfunction after performing catheter ablation in patients with AF (Kato et al, 2021), and observed de novo appearance of CMBs in correspondence with preexisting embolic microinfarctions. To investigate the possibility that hemorrhagic transformation of embolic microinfarction can account for de novo CMBs in patients with AF, we quantitatively investigated the association between embolic microinfarctions and CMBs on brain MRI.…”