Abstract
Purpose: We aimed to identify the predictors of silent cerebral ischemic lesions (SCILs) detected on diffusion-weighted imaging (DWI) after catheter ablation of atrial fibrillation (AF) in patients with oral anticoagulants (OACs), and to determine whether postablation DWI-positive lesions develop into established cerebral infarcts or not on follow-up magnetic resonance imaging (MRI). Methods: This study prospectively included 183 consecutive AF patients (65±9 years; 133 males; paroxysmal/persistent/long-standing persistent AF [LSP-AF], 93/58/32) who received OAC therapy more than 3 weeks before an AF ablation and underwent MRI on the next day after the procedure. Warfarin (n=30; group W) was continued, while dabigatran (n=30; group D), rivaroxaban (n=62; group R), and apixaban (n=61; group A) were discontinued on the day of the procedure. Just after the femoral venous puncture during the procedure, a heparin bolus of 5000 units in group W and 10000 units in the others was given, followed by a continuous and additional bolus infusion of heparin to maintain an activated clotting time of 300-350 seconds. OAC therapy was continued for at least 3 months after the procedure in all patients. Results: A total of 38 lesions in 26 asymptomatic patients (14.1%) were detected on DWI. The incidence of SCILs was 10.0% in group W, 30.0% in group D, 8.1% in group R, and 14.8% in group A, respectively. The BNP level and percentage of patients with LSP-AF, dabigatran, and electrical cardioversion during the procedure were significantly higher in the patients with SCILs than in those without (all P<0.05). In a multivariate logistic regression analysis, LSP-AF and the use of dabigatran were significant positive predictors of SCILs (odds ratios, 5.736 and 4.295; 95% confidence intervals, 2.163-15.212 and 1.541-11.966; P<0.001 and 0.005). Of the 26 patients with SCILs, 8 with 11 lesions underwent follow-up MRI 161±54 days after the procedure. All 11 DWI-positive lesions disappeared and none resulted in subsequent infarcts on follow-up MRI. Conclusions: LSP-AF and dabigatran use were high risk factors for SCILs after AF ablation among the patients with OACs. However, no SCILs developed into chronic cerebral infarcts under continuous oral anticoagulation following the ablation.
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