Silent brain lesions due to thrombogenicity of the
procedure represent recognized side effects of atrial fibrillation (AF)
catheter ablation. Embolic risk is higher if anticoagulation is inadequate and
recent studies suggest that uninterrupted anticoagulation, ACT levels above 300
seconds and administration of a pre-transeptal bolus of heparin might
significantly reduce the incidence of silent cerebral ischemia (SCI) to 2%.
Asymptomatic new lesions during AF ablation should
suggest worse neuropsychological outcome as a result of the association between
silent cerebral infarcts and increased long-term risk of dementia in
non-ablated AF patients. However, the available data are discordant. To date,
no study has definitely linked post-operative asymptomatic cerebral events to a
decline in neuropsychological performance. Larger volumes of cerebral lesions
have been associated with cognitive decline but are uncommon findings acutely
in post-ablation AF patients. Of note, the majority of acute lesions have a
small or medium size and often regress at a medium-term follow-up.
Successful AF ablation has the potential to reduce the
risk of larger SCI that may be considered as part of the natural course of AF.
Although the long-term implications of SCI remain unclear, it is conceivable
that strategies to reduce the risk of SCI may be beneficial.
Credits: G B Forleo; D G Della Rocca; C Lavalle; M Mantica; L P Papavasileiou; V Ribatti; G Panattoni; L Santini; A Natale; L Di Biase