Department of Neurology, Center for Stroke Research Berlin, Department of Cardiology and Pneumology, and Excellence Cluster NeuroCure, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Circ Arrhythm Electrophysiol. 2013 Oct;6(5):843-50. doi: 10.1161/CIRCEP.113.000174. Epub 2013 Aug 29.
MRI-detected brain lesions are common after left atrial catheter ablation for symptomatic atrial fibrillation. The clinical relevance of these acute ischemic lesions is not fully understood, but ablation-related cerebral injury could contribute to cognitive dysfunction.
In the prospective Mesh Ablator versus Cryoballoon Pulmonary Vein Ablation of Symptomatic Paroxysmal Atrial Fibrillation (MACPAF) study, serial 3-T brain MRIs and neuropsychological assessment were performed to analyze the rate of ablation-related brain lesions and their effect on cognitive function. Thirty-seven patients with paroxysmal atrial fibrillation (median age, 63.0 [interquartile range, 57-68] years; 41% female; median CHA2DS2VASc score 2 [interquartile range, 1-3]) underwent 41 ablation procedures according to study criteria. None of these patients had overt neurological deficits after ablation. High-resolution diffusion-weighted imaging, performed within 48 hours after ablation, showed that new brain lesions (range, 1-17) were present in 16 (43.2%) patients after 18 (43.9%) left atrial catheter ablation procedures. Follow-up MRI at 6 months (median, 6.5; interquartile range, 6-7) revealed that 7 (12.5%) of the 56 total acute brain lesions after ablation formed a persistent glial scar in 5 (31.3%) patients. Large diffusion-weighted imaging lesions and a corresponding fluid-attenuated inversion recovery lesion 48 hours after ablation predicted lesion persistence on 6-month follow-up. Neither persistent brain lesions nor the ablation procedure itself had a significant effect on attention or executive functions, short-term memory, or verbal and nonverbal learning after 6 months.
Ablation-related acute ischemic brain lesions persist to some extent but do not cause cognitive impairment 6 months after the ablation procedure.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01061931.
在接受左心房导管消融术治疗有症状的心房颤动后，磁共振成像（MRI）检测到的脑部病变较为常见。这些急性缺血性病变的临床意义尚未完全明确，但消融相关的脑损伤可能导致认知功能障碍。
在前瞻性的网状消融器与冷冻球囊肺静脉消融治疗有症状的阵发性心房颤动（MACPAF）研究中，连续进行了 3T 脑部 MRI 和神经心理学评估，以分析消融相关脑损伤的发生率及其对认知功能的影响。37 例阵发性心房颤动患者（中位年龄 63.0 岁[四分位距 57-68 岁]；41%为女性；中位 CHA2DS2VASc 评分 2 分[四分位距 1-3 分]）根据研究标准进行了 41 次消融手术。消融术后，所有患者均无明显的神经功能缺损。在消融后 48 小时内进行高分辨率弥散加权成像检查显示，16 例（43.2%）患者的 18 次左心房导管消融术后出现新的脑部病变（范围 1-17 个）。6 个月时的随访 MRI（中位数 6.5 岁[四分位距 6-7 岁]）显示，消融后共有 56 个急性脑部病变，其中 7 个（12.5%）在 5 例患者（31.3%）中形成了持续的神经胶质瘢痕。48 小时后弥散加权成像病变较大且液体衰减反转恢复病变相应出现，提示 6 个月随访时病变持续存在。无论是持续的脑部病变还是消融手术本身，都不会在 6 个月后对注意力或执行功能、短期记忆或言语和非言语学习造成显著影响。
消融相关的急性缺血性脑部病变在一定程度上持续存在，但不会在消融术后 6 个月导致认知障碍。
