Brain Lesions After Left Atrial Catheter Ablation for Atrial Fibrillation

Just ran across this article from 2013. Has anyone heard anything new? It is rather alarming that these brain lesions show up in a majority of people after ablation.

Neuropsychological Effects of MRI-Detected Brain Lesions After Left Atrial Catheter Ablation for Atrial Fibrillation
[circep.ahajournals.org]

What's less alarming is they found no clinical significance to the lesions. Although the lesions themselves have been detected in other studies, I was unable to find any study showing they had clinical significance. So at this point they appear to be an interesting observation that has no known impact on patients. Will we find out there's a dire consequence 20 years from now? Well, maybe, but catheter ablations already have a 20-year history and no dire long-term consequences have been found so far.

On an anecdotal note, over the last seven years I've undergone six ablations, five of which involved the left atrium. I'm a software engineer for a company that makes scientific instruments, so I spend most of my days solving extremely challenging intellectual problems all day long. It's the sort of job where even a slight intellectual decline would be readily apparent to both me and my employer. I'm happy to report that neither of us has noticed such a decline. :-)

Good point Carey, These silent brain lesions from catheter ablations can be dramatically reduced through state of the art ablation procedural steps such as using uninterrupted anticoagulation protocol religiously where the activated clotting time of ones blood is raised by a large IV Heparin bolus injection BEFORE transeptal puncture access of the lasso mapping catheter and ablation catheter into the left atrium.

Most all expert ablationist have adopted un-interrupted anticoagulation protocol for many years now after Dr Natale's pioneered and published the key randomized trial proving it significantly reduced the risk of embolic events in peri-procedural phase of before, during and for months after the ablation. Natale's group pushed the field to adopt this protocol while he was still director of AFIB ablation at Cleveland Clinic and its been used there and at many top centers not for well over a decade now. Also use of irrigated catheters greatly reduces the burden of added tiny cerebral white spots. The vast majority of which disappear and cannot be detected by MRI within 48 to 72 hours post ablation.

Furthermore, as Carey noted there is no appreciable consequence discovered after some rigorous follow up testing on cognitive function attributable via this tiny white spots that occur that occur only in the context of these limited cardiac procedures ... the same thing can occur from valve surgery and just about any surgery in which the left side of the venous blood supply is accessed.

However, the same can not be said for ongoing poorly addressed AFIB!! The real danger of these tiny white spots comes from the ongoing accumulated burden of these very same type of micro lesion or micro emboli that occur continuously from UNADDRESSED ongoing AFIB/Aflutter!!

People who continue to procrastinate indefinitely in getting an expert ablation when they have been unable to completely put a lid on their AFIB kettle are definitely exposing themselves to significant risk of 'early onset' (before age 70) cognitive disfunction, dementia and fully blown Alzheimers !!

This is the real take home message from these studies and the legions of other studies looking at this growing problem of the long term accumulation of these SCI (Silent Cerebral Ischemia) which is anything but asymptomatic and benign over the long term when it is relentlessly allowed to continue building up slowly, but surely, from poorly controlled atrial arrhythmia.

Along with stroke risk and heart failure risk this is the biggest incentive for getting an expert ablation and just insuring your ablationist uses all the best methods during their procedures to minimize the very small risk posed by the ablation generated tiny white spots.

The situation is like the old Indian proverb: "It often takes aa small thorn to remove a much larger thorn and then you discard both" . The height of folly would be to read such a study posted about and not understand this critical context and possibly be scared off from doing the ablation which would become you very best choice in possibly preventing actual harm in the form of dementia and Alzheimer's' onset far early than it typically appears, if at all, in non-Afibbers.

Shannon

PS I have written several articles on this issue of SCI from poorly addressed long term AFIB as well as the far more limited risk from cardiac procedures like a CA in the AFIB Report during the last 3 years of its publication before I put it on sabbatical as it remains for the time being. You can freely access all 141 issues on this website and the SCI articles can be found in the last few years of publication so far. Just look up the summary content for each issue of the newsletter to find which ones that have this in-depth discussion.



Edited 1 time(s). Last edit at 10/02/2017 11:56PM by Shannon.

Quote
Carey
What's less alarming is they found no clinical significance to the lesions. Although the lesions themselves have been detected in other studies, I was unable to find any study showing they had clinical significance. So at this point they appear to be an interesting observation that has no known impact on patients. Will we find out there's a dire consequence 20 years from now? Well, maybe, but catheter ablations already have a 20-year history and no dire long-term consequences have been found so far.

On an anecdotal note, over the last seven years I've undergone six ablations, five of which involved the left atrium. I'm a software engineer for a company that makes scientific instruments, so I spend most of my days solving extremely challenging intellectual problems all day long. It's the sort of job where even a slight intellectual decline would be readily apparent to both me and my employer. I'm happy to report that neither of us has noticed such a decline. :-)

Hardware engineer here who has designed the high speed serial interfaces in mobile electronics spanning both the Android and iOS "ecosystems", to use a buzz-word. There probably isn't a device on Earth that I'm not in in one shape or another. One ablation only here, but I'm still ticking!

Has your smart phone crashed lately? Oh, wait...

Seriously, though. I think the upside FAR outweighs the downside.