Atrial Fibrillation NETwork association (AFNET), Mendelstr. 11, 48149 Münster, Germany.
Department of Neurology, Universitätsklinikum Würzburg Josef-Schneider-Str. 11, 97080 Würzburg, Germany.
Europace. 2023 Dec 6;25(12). doi: 10.1093/europace/euad323.
Left atrial catheter ablation is well established in patients with symptomatic atrial fibrillation (AF) but associated with risk of embolism to the brain. The present analysis aims to assess the impact of diffusion-weighted imaging (DWI) slice thickness on the rate of magnetic resonance imaging (MRI)-detected ischaemic brain lesions after ablation.
AXAFA-AFNET 5 trial (NCT02227550) participants underwent MRI using high-resolution (hr) DWI (slice thickness: 2.5-3 mm) and standard DWI (slice thickness: 5-6 mm) within 3-48 h after ablation. In 321 patients with analysable brain MRI (mean age 64 years, 33% female, median CHA2DS2-VASc 2), hrDWI detected at least one acute brain lesion in 84 (26.2%) patients and standard DWI in 60 (18.7%; P < 0.01) patients. High-resolution diffusion-weighted imaging detected more lesions compared to standard DWI (165 vs. 104; P < 0.01). The degree of agreement for lesion confirmation using hrDWI vs. standard DWI was substantial (κ = 0769). Comparing the proportion of DWI-detected lesions, lesion distribution, and total lesion volume per patient, there was no difference in the cohort of participants undergoing MRI at 1.5 T (n = 52) vs. 3 T (n = 269).
The pre-specified AXAFA-AFNET 5 sub-analysis revealed significantly increased rates of MRI-detected acute brain lesions using hrDWI instead of standard DWI in AF patients undergoing ablation. In comparison to DWI slice thickness, MRI field strength had a no significant impact in the trial. Comparing the varying rates of ablation-related MRI-detected brain lesions across previous studies has to consider these technical parameters. Future studies should use hrDWI, as feasibility was demonstrated in the multicentre AXAFA-AFNET 5 trial.
左心房导管消融术已在有症状的心房颤动（房颤）患者中得到广泛应用，但与脑部栓塞风险相关。本分析旨在评估弥散加权成像（DWI）层厚对消融后磁共振成像（MRI）检测到的缺血性脑损伤的发生率的影响。
AXAFA-AFNET 5 试验（NCT02227550）参与者在消融后 3-48 小时内行 MRI 检查，采用高分辨率（hr）DWI（层厚：2.5-3mm）和标准 DWI（层厚：5-6mm）。在 321 例可分析脑部 MRI 的患者中（平均年龄 64 岁，33%为女性，中位 CHA2DS2-VASc 为 2），hrDWI 在 84 例（26.2%）患者中检测到至少一处急性脑损伤，而标准 DWI 在 60 例（18.7%）患者中检测到（P < 0.01）。与标准 DWI 相比，hrDWI 检测到更多的病变（165 与 104；P < 0.01）。使用 hrDWI 与标准 DWI 确认病变的一致性程度较高（κ = 0.769）。比较使用 hrDWI 与标准 DWI 检测到的病变比例、病变分布和每位患者的总病变体积，在 MRI 检查采用 1.5T（n = 52）和 3T（n = 269）的两组参与者中无差异。
AXAFA-AFNET 5 的预设亚分析显示，在接受消融治疗的房颤患者中，使用高分辨率 DWI 而非标准 DWI 可显著增加 MRI 检测到的急性脑损伤的发生率。与 DWI 层厚相比，MRI 场强在试验中无显著影响。在比较以往研究中消融相关 MRI 检测到的脑损伤的不同发生率时，必须考虑这些技术参数。未来的研究应使用高分辨率 DWI，因为在多中心 AXAFA-AFNET 5 试验中已经证明了其可行性。
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