Neuropsychological decline after catheter ablation of atrial fibrillation

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 < .001; false discovery rate (FDR)(crit) ≤ .01].

Conclusion: Adverse neuropsychological changes after left atrial catheter ablation are verifiable in verbal memory and, conjoined with ischemic brain lesions on DWI, might represent cerebral side effects of this procedure.