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MRI-Detected Brain Lesions and Cognitive Function in Patients With Atrial Fibrillation Undergoing Left Atrial Catheter Ablation in the Randomized AXAFA-AFNET 5 Trial.

Publication ,  Journal Article
Haeusler, KG; Eichner, FA; Heuschmann, PU; Fiebach, JB; Engelhorn, T; Blank, B; Callans, D; Elvan, A; Grimaldi, M; Hansen, J; Hindricks, G ...
Published in: Circulation
March 22, 2022

BACKGROUND: We aimed to assess the prevalence of ischemic brain lesions detected by magnetic resonance imaging and their association with cognitive function 3 months after first-time ablation using continuous oral anticoagulation in patients with paroxysmal atrial fibrillation (AF). METHODS: We performed a prespecified analysis of the AXAFA-AFNET 5 trial (Anticoagulation Using the Direct Factor Xa Inhibitor Apixaban During Atrial Fibrillation Catheter Ablation: Comparison to Vitamin K Antagonist Therapy), which randomized 674 patients with AF 1:1 to uninterrupted apixaban or vitamin K antagonist therapy before first-time ablation. Brain magnetic resonance imaging using fluid-attenuated inversion recovery and high-resolution diffusion-weighted imaging was obtained within 3 to 48 hours after AF ablation in all eligible patients enrolled in 25 study centers in Europe and the United States. Patients underwent cognitive assessment 3 to 6 weeks before ablation and 3 months after ablation using the Montreal Cognitive Assessment (MoCA). RESULTS: In 84 (26.1%) of 321 patients with analyzable magnetic resonance imaging, high-resolution diffusion-weighted imaging detected at least 1 acute brain lesion, including 44 (27.2%) patients treated with apixaban and 40 (24.8%) patients treated with vitamin K antagonist (P=0.675). Median MoCA score was similar in patients with or without acute brain lesions at 3 months after ablation (28 [interquartile range (IQR), 26-29] versus 28 [IQR, 26-29]; P=0.948). Cerebral chronic white matter damage (defined as Wahlund score ≥4 points) detected by fluid-attenuated inversion recovery was present in 130 (40.5%) patients and associated with lower median MoCA scores before ablation (27 [IQR, 24-28] versus 27 [IQR, 25-29]; P=0.026) and 3 months after ablation (27 [IQR, 25-29] versus 28 [IQR, 26-29]; P=0.011). This association was no longer significant when adjusted for age and sex. Age was associated with lower MoCA scores before ablation (relative risk, 1.02 per 10 years [95% CI, 1.01-1.03]) and 3 months after ablation (relative risk, 1.02 per 10 years [95% CI, 1.01-1.03]). CONCLUSIONS: Chronic white matter damage as well as acute ischemic lesions detected by brain magnetic resonance imaging were found frequently after first-time ablation for paroxysmal AF using uninterrupted oral anticoagulation. Acute ischemic brain lesions detected by high-resolution diffusion-weighted imaging were not associated with cognitive function at 3 months after ablation. Lower MoCA scores before and after ablation were associated only with older age, highlighting the safety of AF ablation on uninterrupted oral anticoagulation. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02227550.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

March 22, 2022

Volume

145

Issue

12

Start / End Page

906 / 915

Location

United States

Related Subject Headings

  • Vitamin K
  • Treatment Outcome
  • Magnetic Resonance Imaging
  • Humans
  • Cognition
  • Catheter Ablation
  • Cardiovascular System & Hematology
  • Brain
  • Atrial Fibrillation
  • Anticoagulants
 

Citation

APA
Chicago
ICMJE
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Haeusler, K. G., Eichner, F. A., Heuschmann, P. U., Fiebach, J. B., Engelhorn, T., Blank, B., … Kirchhof, P. (2022). MRI-Detected Brain Lesions and Cognitive Function in Patients With Atrial Fibrillation Undergoing Left Atrial Catheter Ablation in the Randomized AXAFA-AFNET 5 Trial. Circulation, 145(12), 906–915. https://doi.org/10.1161/CIRCULATIONAHA.121.056320
Haeusler, Karl Georg, Felizitas A. Eichner, Peter U. Heuschmann, Jochen B. Fiebach, Tobias Engelhorn, Benjamin Blank, David Callans, et al. “MRI-Detected Brain Lesions and Cognitive Function in Patients With Atrial Fibrillation Undergoing Left Atrial Catheter Ablation in the Randomized AXAFA-AFNET 5 Trial.Circulation 145, no. 12 (March 22, 2022): 906–15. https://doi.org/10.1161/CIRCULATIONAHA.121.056320.
Haeusler KG, Eichner FA, Heuschmann PU, Fiebach JB, Engelhorn T, Blank B, et al. MRI-Detected Brain Lesions and Cognitive Function in Patients With Atrial Fibrillation Undergoing Left Atrial Catheter Ablation in the Randomized AXAFA-AFNET 5 Trial. Circulation. 2022 Mar 22;145(12):906–15.
Haeusler, Karl Georg, et al. “MRI-Detected Brain Lesions and Cognitive Function in Patients With Atrial Fibrillation Undergoing Left Atrial Catheter Ablation in the Randomized AXAFA-AFNET 5 Trial.Circulation, vol. 145, no. 12, Mar. 2022, pp. 906–15. Pubmed, doi:10.1161/CIRCULATIONAHA.121.056320.
Haeusler KG, Eichner FA, Heuschmann PU, Fiebach JB, Engelhorn T, Blank B, Callans D, Elvan A, Grimaldi M, Hansen J, Hindricks G, Al-Khalidi HR, Mont L, Nielsen JC, Piccini JP, Schotten U, Themistoclakis S, Vijgen J, Di Biase L, Kirchhof P. MRI-Detected Brain Lesions and Cognitive Function in Patients With Atrial Fibrillation Undergoing Left Atrial Catheter Ablation in the Randomized AXAFA-AFNET 5 Trial. Circulation. 2022 Mar 22;145(12):906–915.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

March 22, 2022

Volume

145

Issue

12

Start / End Page

906 / 915

Location

United States

Related Subject Headings

  • Vitamin K
  • Treatment Outcome
  • Magnetic Resonance Imaging
  • Humans
  • Cognition
  • Catheter Ablation
  • Cardiovascular System & Hematology
  • Brain
  • Atrial Fibrillation
  • Anticoagulants