Hyperintense Brain Lesions in Asymptomatic Low Risk Patients with Paroxysmal Atrial Fibrillation Undergoing Radiofrequency Pulmonary Vein Isolation.

Joanna Wieczorek,Iwona Woźniak-Skowerska,Krzysztof Szydło,Katarzyna Mizia-Stec,Anna M Wnuk-Wojnar,Piotr Wieczorek,Anetta Lasek-Bal

doi:10.3390/jcm10040565

Joanna Wieczorek, Iwona Woźniak-Skowerska + Show 5 more

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https://doi.org/10.3390/jcm10040565

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Abstract

Background: The aim was to determine the occurrence, consequences and risk factors for brain white matter hyperintensities (WMH) assessed in magnetic resonance imaging (MRI) in low-risk patients with paroxysmal atrial fibrillation (AF) undergoing radiofrequency pulmonary vein isolation (PVI-RF). Methods: 74 patients with AF (median 58.5 years (IQR 50–63), 45 male) were included. Before and after a minimum of 6 months after PVI-RF, a brain MRI and a mini-mental state examination (MMSE) were performed. Results: Baseline WMH lesions were found in 55 (74.3%) patients and in 48 from 62 (77.4%) patients after PVI-RF. The WMH lesions were more frequent among older patients, with a higher CHA2DS2-Vasc (C—Congestive heart failure/LV dysfunction, H—Hypertension, A—Age, D—Diabetes mellitus, S—Stroke, V—Vascular Disease, Sc—Sex category). Factors affecting the severity of the WMH were: older age, the co-existence of the PFO and coronary artery disease (CAD). After a follow-up period, the factors predisposing to brain WMH lesions occurrence (age, higher BMI and CHA2DS2-Vasc score) and to the more advanced changes (age, higher CHA2DS2-Vasc score, CAD, PFO) were obtained. Conclusions: The presence and severity of cerebral microembolism are associated with age, higher CHA2DS2-Vasc score and the coexistence of PFO and CAD. PVI-RF procedure and its efficacy does not influence on MRI lesions. In this population, cerebral microembolism is not related to cognitive impairment.

Highlights

First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Department of Neurology, School of Medicine in Katowice, Medical University of Silesia, Abstract: Background: The aim was to determine the occurrence, consequences and risk factors for brain white matter hyperintensities (WMH) assessed in magnetic resonance imaging (MRI) in low-risk patients with paroxysmal atrial fibrillation (AF) undergoing radiofrequency pulmonary vein isolation (PVI-RF)
This publication represents part of a single-center, non-randomized, prospective study of a population consisting of relatively young patients, with a history of paroxysmal, symptomatic AF, without significant structural heart disease and with a low score obtained in the CHA2DS2-Vasc scale that were classified to PVI-RF procedure
Stable coronary artery disease was diagnosed in 15 patients (19% of the study group), while the study turned out that risk factors for atherosclerosis and coronary artery disease were not related to the effectiveness of PVI-RF procedure

Summary

Introduction

After a follow-up period, the factors predisposing to brain WMH lesions occurrence (age, higher BMI and CHA2DS2-Vasc score) and to the more advanced changes (age, higher CHA2DS2-Vasc score, CAD, PFO) were obtained. Conclusions: The presence and severity of cerebral microembolism are associated with age, higher CHA2DS2-Vasc score and the coexistence of PFO and CAD. PVI-RF procedure and its efficacy does not influence on MRI lesions In this population, cerebral microembolism is not related to cognitive impairment. Brain lesions have been consistently associated with small vessel disease, a higher incidence of dementia, and impaired global cognitive function [4,5,6]. Small vessel disease based on structural changes such as silent brain infarcts, white matter hyperintensities (WMH), and brain micro-bleeding can be a key link between published maps and institutional affiliations

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