Brain magnetic resonance imaging and cognitive alterations after ablation in patients with atrial fibrillation

Natsuko Kato,Tomoyuki Fukuma,Masaaki Ito,Ken-Ichi Tabei,Hidekazu Tomimoto,Hajime Sakuma,Masayuki Satoh,Eitaro Fujii,Masayuki Maeda,Yoshinori Hirata,Akihiro Shindo,Kanako Muraga,Mariko Shiga,Maki Umino,Yuichiro Ii,Yoshihiko Kagawa,Keita Matsuura,Satoshi Fujita

doi:10.1038/s41598-021-98484-w

Natsuko Kato, Tomoyuki Fukuma + Show 16 more

Open Access

https://doi.org/10.1038/s41598-021-98484-w

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Journal: Scientific Reports	Publication Date: Sep 23, 2021
Citations: 18	License type: open-access

Affiliation: Mie University, Nippon Medical School

Abstract

Catheter ablation is an important non-pharmacological intervention for atrial fibrillation (AF), but its effect on the incidence of asymptomatic cerebral emboli and long-term effects on cognitive function remain unknown. We prospectively enrolled 101 patients who underwent AF ablation. Brain magnetic resonance imaging (MRI) (72 patients) and neuropsychological assessments (66 patients) were performed 1–3 days (baseline) and 6 months after ablation. Immediately after ablation, diffusion-weighted MRI and 3-dimensional double inversion recovery (3D-DIR) detected embolic microinfarctions in 63 patients (87.5%) and 62 patients (86.1%), respectively. After 6 months, DIR lesions disappeared in 41 patients. Microbleeds (MBs) increased by 17%, and 65% of the de novo MBs were exactly at the same location as the microinfarctions. Average Mini-Mental State Examination scores improved from 27.9 ± 2.4 to 28.5 ± 1.7 (p = 0.037), and detailed neuropsychological assessment scores showed improvement in memory, constructional, and frontal lobe functions. Ejection fraction, left atrial volume index and brain natriuretic peptide level improved from baseline to 3–6 months after ablation. Despite incidental microemboli, cognitive function was preserved 6 months after ablation.

Highlights

Catheter ablation is an important non-pharmacological intervention for atrial fibrillation (AF), but its effect on the incidence of asymptomatic cerebral emboli and long-term effects on cognitive function remain unknown
Our prospective study indicated that ablation has beneficial effects on overall neuropsychological scores despite the incidental embolic microinfarctions caused by the procedure
There was an increase in ejection fraction (EF) and a decrease in left atrial volume index (LAVI) and brain natriuretic peptide (BNP), which may be attributable to improved cardiac function, and which might have led to a net beneficial effect on neuropsychological scores

Summary

Introduction

Catheter ablation is an important non-pharmacological intervention for atrial fibrillation (AF), but its effect on the incidence of asymptomatic cerebral emboli and long-term effects on cognitive function remain unknown. Brain magnetic resonance imaging (MRI) (72 patients) and neuropsychological assessments (66 patients) were performed 1–3 days (baseline) and 6 months after ablation. Atrial fibrillation (AF) contributes to the incidence and outcome of ischemic stroke[4] as well as the occurrence of cognitive impairment/dementia[5,6,7,8,9] These AF risks are increased in elderly individuals because the prevalence of AF increases linearly with a ge[10]. In patients with AF and small vessel disease, magnetic resonance imaging (MRI) of the brain shows various vascular lesions, such as cerebral MBs, white matter hyperintensities, and lacunar infarcts[15]

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