Abstract
BackgroundAtrial fibrillation (AF) without other stroke risk factors is assumed to have a low annual stroke risk comparable to patients without AF. Therefore, current clinical guidelines do not recommend oral anticoagulation for stroke prevention of AF in patients without stroke risk factors. We analyzed brain magnetic resonance imaging (MRI) imaging to estimate the rate of clinically inapparent (“silent”) ischemic brain lesions in these patients.MethodsWe pooled individual patient-level data from three prospective studies comprising stroke-free patients with symptomatic AF. All study patients underwent brain MRI within 24–48 h before planned left atrial catheter ablation. MRIs were analyzed by a neuroradiologist blinded to clinical data.ResultsIn total, 175 patients (median age 60 (IQR 54–67) years, 32% female, median CHA2DS2-VASc = 1 (IQR 0–2), 33% persistent AF) were included. In AF patients without or with at least one stroke risk factor, at least one silent ischemic brain lesion was observed in 4 (8%) out of 48 and 10 (8%) out of 127 patients, respectively (p > 0.99). Presence of silent ischemic brain lesions was related to age (p = 0.03) but not to AF pattern (p = 0.77). At least one cerebral microbleed was detected in 5 (13%) out of 30 AF patients without stroke risk factors and 25 (25%) out of 108 AF patients with stroke risk factors (p = 0.2). Presence of cerebral microbleeds was related to male sex (p = 0.04) or peripheral artery occlusive disease (p = 0.03).ConclusionIn patients with symptomatic AF scheduled for ablation, brain MRI detected silent ischemic brain lesions in approximately one in 12 patients, and microbleeds in one in 5 patients. The prevalence of silent ischemic brain lesions did not differ in AF patients with or without further stroke risk factors.
Highlights
Atrial fibrillation (AF) without other stroke risk factors is assumed to have a low annual stroke risk comparable to patients without AF
Patients recruited in Bocholt, Germany had more frequently congestive heart failure compared to MACPAF patients enrolled in Berlin, Germany (21% vs. 2%, p = 0.04) or patients enrolled in Linz, Austria (21% vs. 6%, p = 0.02), respectively
All MACPAF patients had paroxysmal AF, whereas 61% of all patients enrolled in Linz, Austria and 50% of all patients enrolled in Bocholt presented with paroxysmal AF (p < 0.001)
Summary
Atrial fibrillation (AF) without other stroke risk factors is assumed to have a low annual stroke risk comparable to patients without AF. Brain magnetic resonance imaging (MRI) may help to better quantify the stroke risk of AF patients without stroke risk factors by assessing clinically “silent” ischemic brain lesions, known to be related to clinical evident stroke [8, 9] and dementia [10, 11]. In order to analyze whether silent ischemic brain lesions are found more frequently in AF patients with at least one stroke risk factor compared to those without stroke risk factors, we retrospectively analyzed individual patient data assessed in three prospective monocenter studies focusing on MRI-detected brain lesions after left atrial catheter ablation for symptomatic AF in Germany or Austria [16, 17]. We compared the frequency of cerebral microbleeds or white matter hyperintensities (WMH) in AF patients with or without stroke risk factors
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