Neuropsychological decline after catheter ablation of atrial fibrillation
Neuropsychological decline after catheter ablation of atrial fibrillation
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DOI：
10.1016/j.hrthm.2010.07.035
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发表时间：
2010-12-01
期刊：
影响因子：
5.5
通讯作者：
Gerriets, Tibo
中科院分区：
文献类型：
--
作者：
Schwarz, Niko;Kuniss, Malte;Gerriets, Tibo
背景：脑栓塞事件是导管消融治疗复发性房颤（AF）后公认的副作用。目的：本研究旨在分析治疗性左心房导管消融AF后的神经心理学结局，并检测新的栓塞性缺血性脑病变。方法：我们纳入了23例接受择期环肺静脉电隔离术的复发性AF患者。主要终点是干预后3个月的神经心理学结局，与无消融的非AF对照组（n = 23）的结果形成对比，并与基线性能协方差一致。21例房颤患者分别于介入治疗前、介入治疗后2- 4d和3个月行脑弥散加权磁共振成像（DWI）检查。结果介入治疗后不久，3/21例患者（14.3%）在DWI上发现新的缺血性病灶。在一个病人中，发生了严重的临床症状的区域性大脑中动脉梗死。另外2例患者为临床上无症状的小病变。与对照组相比，在基线表现的协方差中，消融组在言语记忆（五个认知领域之一）方面表现出更差的神经心理学结果，效应量为d = 0.93[t（.05; 42）= -3.53; P
BACKGROUND Cerebral embolic events represent recognized side effects after catheter ablation in the treatment of recurrent atrial fibrillation (AF).OBJECTIVE The study was performed to analyze the neuropsychological outcome and to detect new embolic ischemic brain lesions after therapeutic left atrial catheter ablation of AF.METHODS We enrolled 23 patients with recurrent AF who underwent elective circumferential pulmonary vein isolation. The primary endpoint was the neuropsychological outcome 3 months after intervention in contrast to the results of non-AF controls (n = 23) without ablation and in covariance of baseline performance. Cerebral diffusion-weighted magnetic resonance imaging (DWI) was performed in 21 AF patients at baseline, 2-4 days, and 3 months after intervention.RESULTS In 3/21 patients (14.3%), new ischemic lesions were detected on DWI shortly after intervention. In one patient, a territorial middle cerebral artery infarct occurred with severe clinical symptoms. The other two patients represented clinically silent small lesions. In contrast to the control group and in covariance of baseline performance, the ablation group showed worse neuropsychological outcome in verbal memory (one of five cognitive domains) with an effect size of d = 0.93[t (.05; 42) = -3.53; P