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Cerebral Microbleeds With Atrial Fibrillation After Ablation Therapy
Yoshinori Hirata1, Natsuko Kato1,2, Kanako Muraga1,3
1Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan.
Background:
The prevalence of cerebral microbleeds (CMBs) is significantly higher in patients with atrial fibrillation (AF) than in those without AF. CMBs in patients with AF have been reported to be primarily of the lobar type, but the exact cause of this remains unknown. We investigated the possibility that hemorrhagic transformation of embolic microinfarction can account for de novo lobar CMBs.
Methods:
A total of 101 patients who underwent ablation therapy for AF were prospectively registered, and 72 patients completed the assessment with MRI 6 months after catheter ablation. Brain MRI, including diffusion-weighted imaging (DWI) and susceptibility-weighted imaging (SWI), were examined at 1-3 days (baseline) and 6 months after catheter ablation. We quantitatively evaluated the spatial and temporal distribution of embolic microinfarctions and de novo CMBs.
Results:
Of the 101 patients, 68 were enrolled in this study. Fifty-nine patients (86.8%) showed embolic microinfarctions on baseline DWI immediately after catheter ablation. There were 137 CMBs in SWI, and 96 CMBs were of the lobar type. Six months later, there were 208 CMBs, including 71 de novo CMBs, and 60 of 71 (84.5%) were of the lobar type. Of the 71 de novo CMBs, 56 (78.9%) corresponded to the location of previous embolic microinfarctions found on baseline DWI. The platelet count was significantly lower and hematocrit/hemoglobin and Fazekas score were higher in the group with de novo CMBs than in the group without de novo CMBs.
Conclusion:
De novo CMBs frequently appeared after catheter ablation therapy. Our results suggest that embolic microinfarction can cause lobar CMBs.
Insights
Embolic microinfarctions following atrial fibrillation ablation can transform into new lobar cerebral microbleeds. This study suggests a link between these microinfarctions and the development of new microbleeds in patients with atrial fibrillation.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Cerebral microbleeds (CMBs) are more common in patients with atrial fibrillation (AF).
- The origin of lobar CMBs in AF patients is not fully understood.
- This study explores if embolic microinfarctions transform into new lobar CMBs.
Purpose of the Study:
- To investigate the potential link between embolic microinfarctions and the development of new lobar CMBs after AF ablation.
- To quantitatively assess the spatial and temporal relationship between embolic microinfarctions and de novo CMBs.
Main Methods:
- Prospective study of 101 patients undergoing AF ablation, with 72 completing 6-month follow-up MRI.
- Brain MRI (DWI and SWI) performed at baseline and 6 months post-ablation.
- Evaluation of embolic microinfarctions and de novo CMBs, including their location and timing.
Main Results:
- 59% of patients had embolic microinfarctions post-ablation.
- 71 de novo CMBs were observed at 6 months, with 84.5% being lobar.
- 78.9% of de novo CMBs occurred at the site of prior embolic microinfarctions.
Conclusions:
- De novo CMBs frequently develop after catheter ablation for AF.
- Embolic microinfarctions are a likely cause of lobar CMBs in AF patients.
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