Detection of brain lesions after catheter ablation depends on imaging criteria: insights from AXAFA-AFNET 5 trial

Haeusler KG, Eichner FA, Heuschmann PU, Fiebach JB, Engelhorn T, Callans D, De Potter T, Debruyne P, Scherr D, Hindricks G, Al-Khalidi HR, Mont L, Kim WY, Piccini JP, Schotten U, Themistoclakis S, Di Biase L, Kirchhof P (2023)

Publication Type: Journal article

Publication year: 2023

Journal

Europace Oxford University Press

Book Volume: 25

Article Number: euad323

Journal Issue: 12

DOI: 10.1093/europace/euad323

Abstract

Aims Left atrial catheter ablation is well established in patients with symptomatic atrial fibrillation (AF) but associated with risk of embolism to the brain. The present analysis aims to assess the impact of diffusion-weighted imaging (DWI) slice thickness on the rate of magnetic resonance imaging (MRI)–detected ischaemic brain lesions after ablation. Methods AXAFA-AFNET 5 trial (NCT02227550) participants underwent MRI using high-resolution (hr) DWI (slice thickness: and results 2.5–3 mm) and standard DWI (slice thickness: 5–6 mm) within 3–48 h after ablation. In 321 patients with analysable brain MRI (mean age 64 years, 33% female, median CHA2DS2-VASc 2), hrDWI detected at least one acute brain lesion in 84 (26.2%) patients and standard DWI in 60 (18.7%; P < 0.01) patients. High-resolution diffusion-weighted imaging detected more lesions compared to standard DWI (165 vs. 104; P < 0.01). The degree of agreement for lesion confirmation using hrDWI vs. standard DWI was substantial (κ = 0769). Comparing the proportion of DWI-detected lesions, lesion distribution, and total lesion volume per patient, there was no difference in the cohort of participants undergoing MRI at 1.5 T (n = 52) vs. 3 T (n = 269). Conclusion The pre-specified AXAFA-AFNET 5 sub-analysis revealed significantly increased rates of MRI-detected acute brain lesions using hrDWI instead of standard DWI in AF patients undergoing ablation. In comparison to DWI slice thickness, MRI field strength had a no significant impact in the trial. Comparing the varying rates of ablation-related MRI-detected brain lesions across previous studies has to consider these technical parameters. Future studies should use hrDWI, as feasibility was demonstrated in the multicentre AXAFA-AFNET 5 trial.

Authors with CRIS profile

Tobias Martin Engelhorn Department of Neuroradiology

Involved external institutions

Imelda vzw BE Belgium (BE) Medizinische Universität Graz AT Austria (AT) Deutsches Herzzentrum Berlin DE Germany (DE) Duke University US United States (USA) (US) Universitat de Barcelona (UB) / University of Barcelona ES Spain (ES) Aarhus University Hospital / Aarhus Universitetshospital DK Denmark (DK) Duke University Health System US United States (USA) (US) Kompetenznetz Vorhofflimmern e. V. / Atrial Fibrillation NETwork (AFNET) DE Germany (DE) Ospedale dell'Angelo IT Italy (IT) Montefiore Medical Center US United States (USA) (US) Julius-Maximilians-Universität Würzburg DE Germany (DE) Charité - Universitätsmedizin Berlin DE Germany (DE) Hospital of the University of Pennsylvania (HUP) US United States (USA) (US) Onze-Lieve-Vrouwziekenhuis (OLV Ziekenhuis, OLVZ) BE Belgium (BE)

How to cite

APA:

Haeusler, K.G., Eichner, F.A., Heuschmann, P.U., Fiebach, J.B., Engelhorn, T., Callans, D.,... Kirchhof, P. (2023). Detection of brain lesions after catheter ablation depends on imaging criteria: insights from AXAFA-AFNET 5 trial. Europace, 25(12). https://doi.org/10.1093/europace/euad323

MLA:

Haeusler, Karl Georg, et al. "Detection of brain lesions after catheter ablation depends on imaging criteria: insights from AXAFA-AFNET 5 trial." Europace 25.12 (2023).

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