Department of Neurology, Justus-Liebig University Giessen, Germany.
Heart Rhythm. 2010 Dec;7(12):1761-7. doi: 10.1016/j.hrthm.2010.07.035. Epub 2010 Aug 3.
Cerebral embolic events represent recognized side effects after catheter ablation in the treatment of recurrent atrial fibrillation (AF).
The study was performed to analyze the neuropsychological outcome and to detect new embolic ischemic brain lesions after therapeutic left atrial catheter ablation of AF.
We enrolled 23 patients with recurrent AF who underwent elective circumferential pulmonary vein isolation. The primary endpoint was the neuropsychological outcome 3 months after intervention in contrast to the results of non-AF controls (n = 23) without ablation and in covariance of baseline performance. Cerebral diffusion-weighted magnetic resonance imaging (DWI) was performed in 21 AF patients at baseline, 2-4 days, and 3 months after intervention.
In 3/21 patients (14.3%), new ischemic lesions were detected on DWI shortly after intervention. In one patient, a territorial middle cerebral artery infarct occurred with severe clinical symptoms. The other two patients represented clinically silent small lesions. In contrast to the control group and in covariance of baseline performance, the ablation group showed worse neuropsychological outcome in verbal memory (one of five cognitive domains) with an effect size of d = 0.93[t (.05; 42) = -3.53; P < .001; false discovery rate (FDR)(crit) ≤ .01].
Adverse neuropsychological changes after left atrial catheter ablation are verifiable in verbal memory and, conjoined with ischemic brain lesions on DWI, might represent cerebral side effects of this procedure.
在治疗复发性心房颤动(AF)时,导管消融后出现脑栓塞事件是公认的副作用。
本研究旨在分析神经心理学结局,并检测 AF 患者经导管左心房消融治疗后是否出现新的栓塞性缺血性脑病变。
我们纳入了 23 例接受选择性环肺静脉隔离的复发性 AF 患者。主要终点是与无消融且基线表现协方差的非 AF 对照组(n=23)相比,介入后 3 个月的神经心理学结局。在 21 例 AF 患者中,在基线、介入后 2-4 天和 3 个月时进行了脑弥散加权磁共振成像(DWI)。
在 3/21 例患者(14.3%)中,DWI 检查发现新的缺血性病变。在 1 例患者中,出现了严重临床症状的区域性大脑中动脉梗死,另外 2 例患者表现为无症状的小病变。与对照组和基线表现协方差相比,消融组在言语记忆(认知领域之一)方面的神经心理学结局更差,效应量为 d=0.93[t(.05;42)=-3.53;P<0.001;假发现率(FDR)(临界)≤.01]。
左心房导管消融后可出现不良的神经心理学变化,联合 DWI 上的缺血性脑病变,可能代表该手术的脑副作用。