To investigate the incidence of cerebral MRI abnormalities in a prospective randomised study of PVAC, nMARQ and thoracoscopic epicardial surgical AF ablation
Patients had cerebral MRIs performed before, immediately after and 3 months after AF ablation. These were randomised, anonymised and independently analysed by three expert interpreters. The Mini Mental State Examination and Montreal Cognitive Assessment tests were used to assess cognitive function.
54 patients (mean age: 65 years, median CHA2DS2-Vasc score: 2) were analysed. No patient had a history of cerebral infarction (CI), but 15.6% of pts had baseline MRI evidence of CI, and 84.4% had white matter change (WMC). 8.3% of all scans showed a potential silent cerebral event (SCE). However, most SCEs appeared on the baseline or 3-month scans, and once MRIs were compared in sequence, 40% of apparent SCEs were shown to be pre-existing. Two PVAC, one nMARQ and no surgical patients had ablation-related SCE. At 3 months, there were no new CIs, but 20% had evidence of progressive WMC. No patient had any clinical neurological abnormality or change in cognitive function detected at any time.
There was a high background rate of SCE in patients undergoing AF ablation. The majority of SCEs were not ablation-related. Cerebral MRIs in AF patients demonstrated a very high rate of baseline undocumented, and then rapidly progressive, asymptomatic WMC. There was no significant difference in ablation-related SCE between PVAC, nMARQ and surgical ablation. The clinical relevance of cerebral MRI changes in AF ablation remains unclear.
Credits: Neil Barlow; Emma Owens; David Sallomi; Neil Sulke