Silent cerebral lesions following catheter ablation for atrial fibrillation: a state-of-the-art review.
Peter CalvertGeorgios KolliasHelmut PürerfellnerVickram V RangaswamyJose OsorioGregory Yoke Hong LipDhiraj GuptaPublished in: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology (2023)
Atrial fibrillation is associated with neurocognitive comorbidities such as stroke and dementia. Evidence suggests that rhythm control-especially if implemented early-may reduce the risk of cognitive decline. Catheter ablation is highly efficacious for restoring sinus rhythm in the setting of atrial fibrillation; however, ablation within the left atrium has been shown to result in MRI-detected silent cerebral lesions. In this state-of-the-art review article, we discuss the balance of risk between left atrial ablation and rhythm control. We highlight suggestions to lower the risk, as well as the evidence behind newer forms of ablation such as very high power short duration radiofrequency ablation and pulsed field ablation.
Keyphrases
- catheter ablation
- atrial fibrillation
- left atrial
- cognitive decline
- left atrial appendage
- radiofrequency ablation
- oral anticoagulants
- mild cognitive impairment
- heart failure
- direct oral anticoagulants
- percutaneous coronary intervention
- subarachnoid hemorrhage
- magnetic resonance imaging
- bipolar disorder
- magnetic resonance
- cognitive impairment
- cerebral ischemia
- computed tomography
- blood pressure
- coronary artery