White Matter Lesions, Cognitive Function, and First-Time Ablation for Atrial Fibrillation

Cerebral, white matter
Cerebral, white matter
A study was conducted to assess brain lesions and cognitive function 3 months following first-time ablation in patients with atrial fibrillation.

After first-time ablation for atrial fibrillation (AF), brain magnetic resonance imaging (MRI)-detected chronic white matter damage and acute ischemic lesions were common but not associated with decreased cognitive function. These findings were published in Circulation.

The AXAFA-AFNET 5 trial (Clinicaltrials.gov identifier: NCT02227550) was a prospective, parallel-group, randomized, open, blinded-outcome study conducted at 49 centers in 8 European countries and the United States. Patients (N=634) were randomized to receive 5 mg apixaban twice daily pre- and post-ablation or vitamin K antagonist (VKA) according to local routine practice indications. Patients were assessed for outcomes from ablation and a subset of patients (n=321) recieved MRI at 3 months.

The patients who received MRI and were randomly assigned to be given apixaban or VKA were aged median 64 (IQR, 58-69) and 64 (IQR, 59-70) years; 32% and 34% were women; BMI was 28 (IQR, 25-30) and 28 (IQR, 25-31); 64% and 60% had paroxysmal AF; and Montreal Cognitive Assessment (MoCA) scores were 27 (IQR, 25-29) and 27 (IQR, 25-28) points, respectively.

Fewer of the patients who did not receive brain MRI had symptomatic heart failure and received cryoenergy ablation (both P <.001).

A total of 84 patients were found to have high-resolution diffusion-weighted imaging (hrDWI) lesions. Patients with lesions were older (P <.001), more had persistent AF (P <.001), more had AF flutters during ablation (P <.001), had higher Wahlund scores (P <.01), had higher CHA2DS2-VASc scores (P =.014), and lower short form (SF-12) physical component scores (P =.024).

Stratified by Wahlund score, patients with a score of 4 or higher (n=130) were older (P <.001), had higher CHA2DS2-VASc scores (P <.001), and lower SF-12 physical component scores (P =.029) and MoCA scores (P =.026).

At baseline, MoCA scores differed on the basis of Wahlund score (P =.026) and age (P <.001) but not hrDWI lesion status (P =.781) or treatment assignment (P =.858). No significant differences were observed for the change in MoCA scores at 3 months on the basis of Wahlund score, age, hrDWI lesions, or treatment assignment.

This study was limited, as it was not specifically designed to detect differences in brain lesions or cognitive function.

“MRI-detected acute ischemic brain lesions as well as chronic white matter damage are found in a relevant proportion of patients after first-time catheter ablation for paroxysmal AF,” the study authors noted. “The AXAFA-AFNET 5 trial revealed no differences of uninterrupted apixaban or VKA on the prevalence of hrDWI-detected acute brain lesions after ablation and cognition at 3-months after ablation.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Häeusler KG, Eichner FA, Heuschmann PU, et al. MRI-Detected brain lesions and cognitive function in atrial fibrillation patients undergoing left atrial catheter ablation in the randomized AXAFA-AFNET 5 Trial. Circulation. Published online February 9, 2022. doi:10.1161/CIRCULATIONAHA.121.056320