Brain magnetic resonance imaging and cognitive alterations after ablation in patients with atrial fibrillation.
Brain magnetic resonance imaging and cognitive alterations after ablation in patients with atrial fibrillation.
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DOI：
10.1038/s41598-021-98484-w
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发表时间：
2021-09-23
影响因子：
4.6
通讯作者：
Tomimoto H
中科院分区：
文献类型：
--
作者：
Kato N;Muraga K;Hirata Y;Shindo A;Matsuura K;Ii Y;Shiga M;Tabei KI;Satoh M;Fujita S;Fukuma T;Kagawa Y;Fujii E;Umino M;Maeda M;Sakuma H;Ito M;Tomimoto H
导管消融是房颤（AF）的一种重要的非药物干预手段，但其对无症状脑栓塞发生率的影响以及对认知功能的长期影响尚不清楚。我们前瞻性地招募了101例接受房颤消融的患者。在消融后1-3天（基线）和6个月分别进行脑磁共振成像（MRI）（72例）和神经心理学评估（66例）。消融后立即，弥散加权MRI和三维双反转恢复（3D-DIR）分别检测到63例（87.5%）和62例（86.1%）的栓塞性微梗死。6个月后，41例患者的DIR病变消失。微出血（MBs）增加了17%，65%的新发MBs与微梗死完全相同。平均精神状态检查分数从27.9±2.4分提高到28.5±1.7分（p = 0.037），详细的神经心理评估分数显示记忆、结构和额叶功能有所改善。射血分数、左房容积指数和脑利钠肽水平在消融后3-6个月较基线有所改善。尽管偶然的微栓子，消融后6个月认知功能得以保留。
Catheter ablation is an important non-pharmacological intervention for atrial fibrillation (AF), but its effect on the incidence of asymptomatic cerebral emboli and long-term effects on cognitive function remain unknown. We prospectively enrolled 101 patients who underwent AF ablation. Brain magnetic resonance imaging (MRI) (72 patients) and neuropsychological assessments (66 patients) were performed 1–3 days (baseline) and 6 months after ablation. Immediately after ablation, diffusion-weighted MRI and 3-dimensional double inversion recovery (3D-DIR) detected embolic microinfarctions in 63 patients (87.5%) and 62 patients (86.1%), respectively. After 6 months, DIR lesions disappeared in 41 patients. Microbleeds (MBs) increased by 17%, and 65% of the de novo MBs were exactly at the same location as the microinfarctions. Average Mini-Mental State Examination scores improved from 27.9 ± 2.4 to 28.5 ± 1.7 (p = 0.037), and detailed neuropsychological assessment scores showed improvement in memory, constructional, and frontal lobe functions. Ejection fraction, left atrial volume index and brain natriuretic peptide level improved from baseline to 3–6 months after ablation. Despite incidental microemboli, cognitive function was preserved 6 months after ablation.
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