A patient with asymptomatic cerebral lesions during AF ablation

How much should we worry?

Giovanni B. Forleo, Domenico G. Della Rocca, Carlo Lavalle, Massimo Mantica, Lida P. Papavasileiou, Valentina Ribatti, Germana Panattoni, Luca Santini, Andrea Natale, Luigi Di Biase

Research output: Contribution to journalReview article

4 Citations (Scopus)

Abstract

Silent brain lesions due to thrombogenicity of the procedure represent recognized side effects of atrial fibrillation (AF) catheter ablation. Embolic risk is higher if anticoagulation is inadequate and recent studies suggest that uninterrupted anticoagulation, ACT levels above 300 seconds and administration of a pre-transeptal bolus of heparin might significantly reduce the incidence of silent cerebral ischemia (SCI) to 2%. Asymptomatic new lesions during AF ablation should suggest worse neuropsychological outcome as a result of the association between silent cerebral infarcts and increased long-term risk of dementia in non-ablated AF patients. However, the available data are discordant. To date, no study has definitely linked post-operative asymptomatic cerebral events to a decline in neuropsychological performance. Larger volumes of cerebral lesions have been associated with cognitive decline but are uncommon findings acutely in post-ablation AF patients. Of note, the majority of acute lesions have a small or medium size and often regress at a medium-term follow-up. Successful AF ablation has the potential to reduce the risk of larger SCI that may be considered as part of the natural course of AF. Although the long-term implications of SCI remain unclear, it is conceivable that strategies to reduce the risk of SCI may be beneficial.

Original languageEnglish (US)
Pages (from-to)67-73
Number of pages7
JournalJournal of Atrial Fibrillation
Volume8
Issue number5
StatePublished - Feb 1 2016

Fingerprint

Atrial Fibrillation
Brain Ischemia
Catheter Ablation
Dementia
Heparin
Incidence
Brain

Keywords

  • Asymptomatic cerebral embolism
  • Atrial fibrillation ablation
  • Magnetic resonance imaging
  • Silent cerebral ischemia
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Forleo, G. B., Della Rocca, D. G., Lavalle, C., Mantica, M., Papavasileiou, L. P., Ribatti, V., ... Di Biase, L. (2016). A patient with asymptomatic cerebral lesions during AF ablation: How much should we worry? Journal of Atrial Fibrillation, 8(5), 67-73.

A patient with asymptomatic cerebral lesions during AF ablation : How much should we worry? / Forleo, Giovanni B.; Della Rocca, Domenico G.; Lavalle, Carlo; Mantica, Massimo; Papavasileiou, Lida P.; Ribatti, Valentina; Panattoni, Germana; Santini, Luca; Natale, Andrea; Di Biase, Luigi.

In: Journal of Atrial Fibrillation, Vol. 8, No. 5, 01.02.2016, p. 67-73.

Research output: Contribution to journalReview article

Forleo, GB, Della Rocca, DG, Lavalle, C, Mantica, M, Papavasileiou, LP, Ribatti, V, Panattoni, G, Santini, L, Natale, A & Di Biase, L 2016, 'A patient with asymptomatic cerebral lesions during AF ablation: How much should we worry?', Journal of Atrial Fibrillation, vol. 8, no. 5, pp. 67-73.
Forleo GB, Della Rocca DG, Lavalle C, Mantica M, Papavasileiou LP, Ribatti V et al. A patient with asymptomatic cerebral lesions during AF ablation: How much should we worry? Journal of Atrial Fibrillation. 2016 Feb 1;8(5):67-73.
Forleo, Giovanni B. ; Della Rocca, Domenico G. ; Lavalle, Carlo ; Mantica, Massimo ; Papavasileiou, Lida P. ; Ribatti, Valentina ; Panattoni, Germana ; Santini, Luca ; Natale, Andrea ; Di Biase, Luigi. / A patient with asymptomatic cerebral lesions during AF ablation : How much should we worry?. In: Journal of Atrial Fibrillation. 2016 ; Vol. 8, No. 5. pp. 67-73.
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