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

Authors

  • KARL GEORG HAEUSLER M.D.,

    1. Department of Neurology, Charité—Universitätsmedizin Berlin, Germany
    2. Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Germany
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    • K.G. Haeusler and L. Koch contributed equally.

  • LYDIA KOCH M.D.,

    1. Department of Cardiology and Pneumology, Charité—Universitätsmedizin Berlin, Germany
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    • K.G. Haeusler and L. Koch contributed equally.

  • JULIANE HERM M.D.,

    1. Department of Neurology, Charité—Universitätsmedizin Berlin, Germany
    2. Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Germany
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  • UTE A. KOPP Ph.D.,

    1. Department of Neurology, Charité—Universitätsmedizin Berlin, Germany
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  • PETER U. HEUSCHMANN M.D.,

    1. Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Germany
    2. Institute of Clinical Epidemiology and Biometry—Universität Würzburg, Germany
    3. Center for Clinical Studies, University Hospital Würzburg
    4. Comprehensive Heart Failure Center, University of Würzburg, Germany
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  • MATTHIAS ENDRES M.D.,

    1. Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Germany
    2. Department of Cardiology and Pneumology, Charité—Universitätsmedizin Berlin, Germany
    3. Excellence Cluster NeuroCure, Charité—Universitätsmedizin Berlin, Germany
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  • HEINZ-PETER SCHULTHEISS M.D.,

    1. Department of Cardiology and Pneumology, Charité—Universitätsmedizin Berlin, Germany
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  • ALEXANDER SCHIRDEWAN M.D.,

    1. Department of Cardiology and Pneumology, Charité—Universitätsmedizin Berlin, Germany
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  • JOCHEN B. FIEBACH M.D.

    1. Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Germany
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  • The project has received funding from the Federal Ministry of Education and Research via the Competence Net Stroke and the grant Center for Stroke Research Berlin (01 EO 0801). M. Endres receives further funding from the DFG (Excellence cluster NeuroCure, SFB TR 43, KFO 247, KFO 213), EU (Eustroke, ARISE, WakeUp), Volkswagen Foundation (Lichtenberg Program) and Corona Foundation.

  • K.G. Haeusler reports lecture fees and a study grant by Sanofi-Aventis and Bayer Healthcare. L. Koch reports lecture fees by Medtronic and a Biotronik sponsored fellowship. M. Endres received grant support from AstraZeneca and Sanofi-Aventis, participated in advisory board meetings of Bayer, Boehringer Ingelheim, Bristol-Myers Squibb (BMS), MSD, Pfizer, and received honoraria from Astra Zeneca, Bayer, Berlin-Chemie, BMS, Boehringer Ingelheim, Desitin, Eisei, Ever, Glaxo Smith Kline, MSD, Novartis, Pfizer, Sanofi-Aventis, Takeda, and Trommsdorff. A. Schirdewan reports lecture fees and earlier study grants by Medtronic, C.R. Bard, and Biotronik. J.B. Fiebach reports receiving consulting, lecture, and advisory board fees by BMS, Siemens, Philips, Perceptive, Bio-Imaging Technologies, Boehringer Ingelheim, Lundbeck, and Sygnis. Other authors: No disclosures.

Dr. Karl Georg Häusler, Charité—Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany, Fax: +49-30-8445-4264, E-mail: georg.haeusler@charite.de

Abstract

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 CHADS2 score had no impact. Lesion volumes varied from 5 to 150 mm3 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)

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