The value of high-resolution diffusion-weighted MRI in the diagnosis of asymptomatic cerebral emboli after atrial fibrillation ablation

doi:10.3877/cma.j.issn.2095-6568.2022.01.002

Abstract

Abstract:

Objective

To compare the incidence and characteristics of atrial fibrillation (AF) ablation-related asymptomatic cerebral emboli(ACE) between high-resolution diffusion-weighted imaging(hDWI) and conventional DWI(cDWI).

Methods

Thirty eight consecutive AF patients in Jiangsu Province Hospital from November 2018 to December 2018, and 18 consecutive AF patients in Shanghai East Hospital from January 2019 to February 2019 who underwent ablation were recruited. All the patients received hDWI, in order to exclude recent events of cerebral embolism. High-resolution DWI and conventional DWI were performed after ablation within 48 h, and the incidence, number, size, and location of ACE in the same patient were compared.

Results

High-resolution DWI showed a higher incidence of acute ACE (70% vs. 42%, P<0.001), a significantly higher number of ACE lesions (102 vs. 42, P<0.001), and a larger ACE size (5.42 mm vs. 4.21 mm, P<0.001) compared to cDWI. Multivariate regression analysis revealed that impaired left ventricular ejection fraction (P=0.012) and low intraoperative active clotting time (P=0.009) were associated with the incidence of ACE.

Conclusion

High-resolution DWI showed higher incidence and greater features of ACE after AF ablation, and MRI settings should be considered in studies evaluating ACE.

Key words: Atrial fibrillation, Catheter ablation, Asymptomatic cerebral emboli, Magnetic resonance imaging, Diffusion-weighted imaging

Xuecheng Wang, Zijun Chen, Yaya Yu, Fenghua Fan, Xin Xie, Yizhang Wu, Dian Cheng, Jian Zhou, Jinbo Yu, Xiaorong Li, Bing Yang, Minglong Chen. The value of high-resolution diffusion-weighted MRI in the diagnosis of asymptomatic cerebral emboli after atrial fibrillation ablation[J]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2022, 10(01): 2-6.

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URL: https://zhxzyxldzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-6568.2022.01.002

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Figures/Tables 4

变量	总体	非ACE组	ACE组	P值
例数	50	15	35
年龄（岁， $x ¯ ± s$ ）	56.38±11.29	51.87±15.23	58.31±8.68	0.064
男［例（%）］	37（74.00）	12（80.00）	25（71.43）	0.527
阵发性心房颤动［例（%）］	22（44.00）	6（40.00）	16（45.71）	0.709
CHA₂DS₂-VASc评分（分， $x ¯ ± s$ ）	2.08±1.51	1.73±1.39	2.23±1.55	0.292
HAS-BLED评分（分， $x ¯ ± s$ ）	0.88±0.90	0.87±0.92	0.89±0.90	0.946
消融史［例（%）］	4（8.00）	3（20.00）	1（2.86）	0.075
高血压［例（%）］	20（40.00）	6（40.00）	14（40.00）	1
糖尿病［例（%）］	4（8.00）	1（6.67）	3（8.57）	0.82
卒中史［例（%）］	4（8.00）	1（6.67）	3（8.57）	0.82
口服抗凝药				0.57
达比加群酯［例（%）］	18（36.00）	6（40.00）	12（34.29）
利伐沙班［例（%）］	22（44.00）	5（33.33）	17（48.57）
华法林［例（%）］	10（20.00）	4（26.67）	6（17.14）
LAD（mm， $x ¯ ± s$ ）	40.72±5.17	39.53±4.85	41.23±5.28	0.292
LVEF（%， $x ¯ ± s$ ）	62.22±4.35	64.33±2.00	61.32±4.77	0.024
ACT（s， $x ¯ ± s$ ）	285.21±30.21	312.17±30.28	273.65±21.90	<0.001
累计操作时间（s， $x ¯ ± s$ ）	192.60±50.18	182.00±38.21	197.14±54.37	0.333
基质标测消融［例（%）］	16（32.00）	4（26.67）	12（34.29）	0.597
电复律［例（%）］	21（42.00）	6（40.00）	15（42.86）	0.851

变量	总体	非ACE组	ACE组	P值
例数	50	15	35
年龄（岁， $x ¯ ± s$ ）	56.38±11.29	51.87±15.23	58.31±8.68	0.064
男［例（%）］	37（74.00）	12（80.00）	25（71.43）	0.527
阵发性心房颤动［例（%）］	22（44.00）	6（40.00）	16（45.71）	0.709
CHA₂DS₂-VASc评分（分， $x ¯ ± s$ ）	2.08±1.51	1.73±1.39	2.23±1.55	0.292
HAS-BLED评分（分， $x ¯ ± s$ ）	0.88±0.90	0.87±0.92	0.89±0.90	0.946
消融史［例（%）］	4（8.00）	3（20.00）	1（2.86）	0.075
高血压［例（%）］	20（40.00）	6（40.00）	14（40.00）	1
糖尿病［例（%）］	4（8.00）	1（6.67）	3（8.57）	0.82
卒中史［例（%）］	4（8.00）	1（6.67）	3（8.57）	0.82
口服抗凝药				0.57
达比加群酯［例（%）］	18（36.00）	6（40.00）	12（34.29）
利伐沙班［例（%）］	22（44.00）	5（33.33）	17（48.57）
华法林［例（%）］	10（20.00）	4（26.67）	6（17.14）
LAD（mm， $x ¯ ± s$ ）	40.72±5.17	39.53±4.85	41.23±5.28	0.292
LVEF（%， $x ¯ ± s$ ）	62.22±4.35	64.33±2.00	61.32±4.77	0.024
ACT（s， $x ¯ ± s$ ）	285.21±30.21	312.17±30.28	273.65±21.90	<0.001
累计操作时间（s， $x ¯ ± s$ ）	192.60±50.18	182.00±38.21	197.14±54.37	0.333
基质标测消融［例（%）］	16（32.00）	4（26.67）	12（34.29）	0.597
电复律［例（%）］	21（42.00）	6（40.00）	15（42.86）	0.851

项目	cDWI	hDWI	P值
ACE	21（42）	35（70）	<0.001
1个病灶	13（61.9）	15（42.9）
2个病灶	5（23.8）	12（34.3）
≥ 3个病灶	3（14.3）	8（22.8）
总病灶数	42	102
平均病灶数	0.84	2.04	<0.001
病灶大小			0.18
<2 mm	1（2.3）	11（10.8）
2 ~5 mm	29（69.1）	69（67.6）
≥ 5mm	12（28.6）	22（21.6）
皮层	31（73.8）	80（78.4）	0.55
左侧大脑半球	24（57.1）	54（52.9）	0.50
病变部位			0.84
额叶	8（19.1）	22（21.6）
顶叶	20（47.6）	47（46.1）
颞叶	3（7.1）	5（4.9）
枕叶	6（14.3）	20（19.6）
小脑前叶	5（11.9）	8（7.8）

项目	单因素分析			多因素分析
项目	OR	95%CI	P值	OR	95%CI	P值
年龄（岁）	1.15	1.00~1.12	0.072
性别（男）	0.63	0.14~2.70	0.528
阵发性心房颤动	1.26	0.37~4.32	0.709
CHA₂DS₂-VASc评分	1.27	0.82~1.98	0.288
高血压	1.00	0.29~3.44	1.000
糖尿病	1.31	0.13~13.74	0.820
LAD（mm）	1.07	0.95~1.20	0.288
LVEF（%）	0.58	0.37~0.90	0.014	0.52	0.27~0.99	0.047
ACT（s）	0.93	0.90~0.97	<0.001	0.94	0.90~0.98	0.003
累计操作时间（s）	1.01	0.99~1.02	0.328
基质标测消融	1.43	0.38~5.48	0.597
电复律	1.12	0.33~3.85	0.851

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