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Silent cerebral events as a result of left atrial catheter ablation do not cause neuropsychological sequelae—a MRI-controlled multicenter study

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Abstract

Purpose

Recently, diffusion-weighted magnetic resonance imaging (DW-MRI) revealed silent cerebral events (SCEs) as an acute complication of pulmonary vein isolation (PVI). We investigated whether SCEs following PVI are associated with neuropsychological deficits observed during patients’ follow-up examinations.

Methods

After PVI, 52 patients were eligible for follow-up. PVI was performed using a variety of ablation technologies (duty-cycled phased radiofrequency (RF) multipolar ablation with the Pulmonary Vein Ablation Catheter® (PVAC) in 24 patients, cooled-tip RF ablation in 23 patients, and cryoballoon ablation in five patients). Fluid-attenuated inversion recovery (FLAIR)- and DW-MRI studies were performed 1 day before PVI and 1 day and 1 month afterward to detect pre-existing cerebral lesions or post-ablation SCEs. At the same times, eight neuropsychological tests were administered. We evaluated changes in patients’ neuropsychological capabilities and compared changes in patients with SCEs to those without SCEs.

Results

FLAIR-MRI revealed pre-existing cerebral lesions in 42 patients (81 %), and DW-MRI demonstrated new SCEs in 25 patients (48 %) (17 treated with phased RF (PVAC) (71 %), six treated with irrigated RF (26 %), and two treated with cryoablation (40 %)). Neuropsychological test results showed no significant impairment (in median z scores) 1 day and 1 month after the ablation procedure. There was no difference in neuropsychological capabilities between patients with SCEs and those without SCEs except in one subtest (part of the verbal working memory test).

Conclusions

The incidence of pre-existing cerebral lesions and post-ablation SCEs was high. The frequency of SCEs depends on the ablation technology used. Neither PVI nor post-ablation SCEs have any effect on neuropsychological capabilities.

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Acknowledgments

We thank Carmen Theek for statistical analysis and the staff in the ablation theater for their continued support in the study. We also thank Jo Ann M. Eliason, MA, ELS(D), for the editing assistance.

Funding

This work was supported by funding (€64.500,–) from Medtronic (Medtronic, Minneapolis, USA).

Conflict of interest

There are no ethical problems and no conflicts of interest for any of the authors related to the material.

Author information

Authors and Affiliations

  1. Department of Cardiology, Rotkreuzklinikum München, Akademisches Lehrkrankenhaus der TU München, Nymphenburgerstr 163, 80634, Munich, Germany

    Christian von Bary

  2. Department of Electrophysiology II, Herz- und Gefäss-Klinik Bad Neustadt, Bad Neustadt, Germany

    Thomas Deneke & Anja Schade

  3. Department of Cardiology and Angiology, Universitäts Herzzentrum Bad Krozingen, Bad Krozingen, Germany

    Thomas Arentz & Heiko Lehrmann

  4. Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany

    Christian von Bary, Christoph Eissnert, Sabine Fredersdorf & Ekrem Ücer

  5. Department of Neurology, University of Regensburg Bezirksklinikum, Regensburg, Germany

    Susanne Schwab-Malek, Dobri Baldaranov & Felix Schlachetzki

  6. Department of Radiology, University Hospital Regensburg, Regensburg, Germany

    Christina Wendl

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  1. Christian von Bary
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Correspondence to Christian von Bary.

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von Bary, C., Deneke, T., Arentz, T. et al. Silent cerebral events as a result of left atrial catheter ablation do not cause neuropsychological sequelae—a MRI-controlled multicenter study. J Interv Card Electrophysiol 43, 217–226 (2015). https://doi.org/10.1007/s10840-015-0004-6

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  • DOI: https://doi.org/10.1007/s10840-015-0004-6

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