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Increase in Cerebral Blood Flow After Catheter Ablation of Atrial Fibrillation.

Authors :: Takahashi Y
Yamamoto T
Oyama J
Sugihara G
Shirai Y
Tao S
Takigawa M
Sato H
Sasaki M
Hirakawa A
Takahashi H
Goya M
Sasano T
Source :: JACC. Clinical electrophysiology [JACC Clin Electrophysiol] 2022 Nov; Vol. 8 (11), pp. 1369-1377. Date of Electronic Publication: 2022 Sep 28.
Publication Year :: 2022
Abstract: Background: Recent studies have found that atrial fibrillation (AF) is a risk factor for cognitive impairment. Brain hypoperfusion is hypothesized as an underlying mechanism of cognitive decline in AF patients. Objectives: This study sought to assess changes in cerebral blood flow (CBF) and brain volume after catheter ablation of AF. Methods: Patients undergoing catheter ablation of AF were enrolled in this prospective study. AF patients being treated with pharmaceuticals alone served as a control group. Brain magnetic resonance imaging was performed before and 6 months after catheter ablation. CBF was assessed by 2-dimensional phase-contrast magnetic resonance angiography. Brain volume and bilateral hippocampal volume were measured using FreeSurfer software. Results: Of the 57 study patients (age 64 ± 11 years; 45 men; paroxysmal AF: n = 22; nonparoxysmal AF: n = 35), 48 patients were freed from tachyarrhythmia recurrence beyond a 3-month blanking period. Changes in CBF and brain perfusion over 6 months were significantly greater in the study patients than control (CBF: 39.26 vs -34.86 mL; P = 0.01, ANCOVA; brain perfusion: 3.78 vs -3.02 mL/100 mL/min; P = 0.009, ANCOVA), while changes in total brain volume and bilateral hippocampal volume were similar between 2 groups (total brain volume: 2.57 vs -2.15 mL; P = 0.32, ANCOVA; bilateral hippocampal volume: 0.03 vs 0.04 mL; P = 0.8, ANCOVA). Nonparoxysmal AF at baseline was an independent predictor of an increase in CBF of >32.6 mL/min. Conclusions: Catheter ablation of AF has favorable effects on CBF, particularly in nonparoxysmal AF. Our results may partially explain the association between cognitive decline and AF. Competing Interests: Funding Support and Author Disclosures Drs Takahashi and Takigawa have received research grants from Medtronic Japan, Boston Scientific, Japan Lifeline, and WIN International. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2022 American College of Cardiology Foundation. All rights reserved.)