Hyperintense Brain Lesions in Asymptomatic Low Risk Patients with Paroxysmal Atrial Fibrillation Undergoing Radiofrequency Pulmonary Vein Isolation
Abstract
:1. Introduction
The Aims of the Study Were
- To determine the occurrence, consequences and risk factors for brain white matter hyperintensities (WMH) assessed in magnetic resonance imaging (MRI) in low-risk patients undergoing PVI-RF.
- To determine risk factors for brain WMH lesions assessed in the brain MRI in low-risk patients before and after PVI-RF.
- To determine the impact of PVI-RF procedure on the occurrence and severity of WMH lesions assessed in the brain MRI.
- To assess a potential relationship of atrial fibrillation with cognitive decline, with particular relation to PVI-RF impact.
2. Materials and Methods
2.1. Magnetic Resonance Imaging
- Grade 1—mild WMH were defined by punctate lesions with a maximum diameter of 9 mm for a single lesion and of 20 mm for grouped lesions.
- Grade 2—moderate WMH were early confluent lesions of 10–20 mm single lesions and >20 mm grouped lesions of any diameter and only connecting bridges between the individual lesions.
- Grade 3—severe WMH were single lesions or confluent areas of hyperintensity ≥ 20 mm in diameter.
2.2. Test Mini-Mental State Examination
2.3. ECG Holter Monitoring
2.4. Transthoracic/Transesophageal Echocardiography and Carotid Ultrasound
2.5. PVI-RF Procedure
2.6. Statistical Analysis
3. Results
3.1. The Study Group Characteristic
3.2. WMH Lesions and Psychological Assessment before PVI-RF Treatment
3.3. WMH Lesions and Psychological Assessment after PVI-RF Treatment
3.4. WMH Lesions and Psychological Assessment Depending on PVI-RF Procedure
4. Discussion
4.1. Study Group
4.2. WMH Lesions before and after the PVI-RF Procedure
4.3. Psychological Assessment before and after the PVI-RF Procedure
4.4. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristic | Study Group (n = 74) |
---|---|
Age, y | 58.5 (50–63) |
Male gender | 45 (60.8%) |
AF duration: | |
● 0–5 y | 33 (44.6%) |
● 5–10 y | 26 (35.1%) |
● >10 y | 15 (20.3%) |
Height, cm | 174.2 ± 10.1 |
Weight, kg | 88.7 ± 15.6 |
BMI, kg/m2 | 29.2 ± 4.4 |
BSA, m2 | 2.06 ± 0.22 |
PLT, ×103 | 185 (162–215) |
APTT, sec. | 1.4 (1.3–1.6) |
INR | 1.9 ± 0.4 |
EHRA score | 3 (2–3) |
CHA2DS2-Vasc score | 2 (1–3) |
PFO | 20 (27%) |
Echogenic blood in the left atrium appendage: | |
● Absent | 63 (85.1%) |
● 1 grade | 9 (12.2%) |
● 2 grade | 2 (2.7%) |
Coronary artery disease | 15 (20.3%) |
Arterial hypertension | 50 (67.6%) |
Diabetes mellitus | 15 (20.3%) |
Hyperlipidemia | 55 (67.6%) |
Obesity | 26 (35.1%) |
Tobacco smoking: | |
● Never | 44 (59.5%) |
● In the past | 21 (28.4%) |
● Active | 9 (12.2%) |
Characteristic | WMH Absent (n = 19) | Fazekas 1 Grade (n = 48) | Fazekas 2 Grade (n = 4) | Fazekas 3 Grade (n = 3) | p Value |
---|---|---|---|---|---|
MMSE | 30 (28–30) | 29 (28–30) | 29 (27–30) | 29 (29–30) | 0.31 |
Age, y | 44 (38–56) | 60 (56.5–63.5) | 65,5 (56–69) | 60 (40–66) | 0.0005 |
CHA2DS2-Vasc score | 1 (0–2) | 2 (1–3) | 3 (2–3) | 1 (1–4) | 0.04 |
PFO | 7 (36.8%) | 8 (17%) | 2 (50%) | 3 (100%) | 0.006 |
CAD | 1 (5.3%) | 11 (22.9%) | 3 (75%) | 0 (%) | 0.01 |
Arterial hypertension | 10 (52.6%) | 34 (70,8) | 4 (100%) | 2 (66.7%) | 0.25 |
Diabetes mellitus | 2 (10.5%) | 12 (25%) | 0 (0%) | 1 (33.3%) | 0.37 |
Hyperlipidemia | 11 (57.9%) | 34 (70.8) | 4 (100%) | 1 (33.3%) | 0.2 |
Obesity | 4 (21.1%) | 19 (39.6%) | 1 (25%) | 2 (66.7%) | 0.31 |
Tobacco smoking: | |||||
• Never | 11 (57.9%) | 30 (62.5%) | 3 (75%) | 0 (0%) | 0.1 |
• In the past | 5 (26.3%) | 14 (29.2) | 2 (25%) | 1 (33.3%) | 0.1 |
• Active | 3 (15.8%) | 4 (8.3) | 0 (%) | 2 (66.7%) | 0.1 |
AF duration: | |||||
• 0–5 y | 8 (42.1%) | 25 (52.1%) | 0 (%) | 0 (0%) | 0.1 |
• 5–10 y | 6 (31.6%) | 17 (35.4%) | 2 (50%) | 1 (33.3%) | 0.1 |
• >10 y | 5 (26.3%) | 6 (12.5%) | 2 (50%) | 2 (66.7%) | 0.1 |
BMI | 27.1 (26.2–29.7) | 29.2 (26.3–33) | 26.7 (25.9–30.7) | 32.5 (25.2–35.1) | 0.37 |
Characteristic | WMH Absent (n = 14) | Fazekas 1 Grade (n = 40) | Fazekas 2 Grade (n = 6) | Fazekas 3 Grade (n = 2) | p Value |
---|---|---|---|---|---|
MMSE | 30 (28–30) | 29 (28–30) | 27 (26–29) | 29.5 (29–30) | 0.15 |
Age, y | 45 (39–56) | 61 (56–64) | 65 (58–66) | 53 (40–66) | 0.001 |
CHA2DS2-Vasc score | 1 (1–2) | 2 (1–3) | 3 (3–3) | 2.5 (1–4) | 0.02 |
PFO | 5 (35.7%) | 7 (18%) | 2 (33.3%) | 2 (100%) | 0.05 |
CAD | 1 (7.1%) | 9 (22.5%) | 4 (66.7%) | 0 (0%) | 0.03 |
Arterial hypertension | 8 (42.9%) | 28 (70%) | 6 (100%) | 2 (100%) | 0.2 |
Diabetes mellitus | 1 (7.1%) | 10 (25%) | 0 (0%) | 1 (50%) | 0.19 |
Hyperlipidemia | 10 (71.4%) | 26 (65%) | 6 (100%) | 1 (50%) | 0.34 |
Obesity | 2 (14.3%) | 15 (37,5%) | 1 (16,7%) | 1 (50%) | 0.31 |
Tobacco smoking: | |||||
● Never | 7 (50%) | 27 (67.5%) | 4 (66,7%) | 0 (0%) | 0.36 |
● In the past | 4 (28.6%) | 9 (22.5%) | 2 (33.3%) | 1 (50%) | 0.36 |
● Active | 3 (21.4%) | 0 (0%) | 0 (0%) | 1 (50%) | 0.36 |
AF duration: | |||||
● 0–5 y | 5 (35.7%) | 20 (50%) | 1 (16.7%) | 0 (0%) | 0.3 |
● 5–10 y | 4 (28.6%) | 15 (37.5%) | 3 (50%) | 1 (50%) | 0.3 |
● >10 y | 5 (35.7%) | 5 (12.5%) | 2 (33.3%) | 1 (50%) | 0.3 |
BMI | 27 (26.2–29.4) | 29.2 (26.5–32.7) | 26.1 (25.5–27.1) | 30.2 (25.2–35.1) | 0.2 |
PVI-RF effective (n = 37) | 6 (19.4%) | 21 (67.7%) | 3 (9.7%) | 1 (3.2%) | 0.9 |
PVI-RF ineffective (n = 35) | 8 (26.7%) | 18 (60%) | 3 (10%) | 1 (3.3%) | 0.9 |
Characteristic | Before PVI-RF n = 74 | After PVI-RF n = 62 | p Value |
---|---|---|---|
WMH presence | 55 (74.3%) | 48 (77.4%) | 0.1 |
WMH severity | 1 (0–1) | 1 (1–1) | 0.1 |
WMH severity: | |||
● Fazekas 0, grade | 19 (25.7%) | 14 (22.6%) | |
● Fazekas 1, grade | 48 (64.9%) | 40 (64.5%) | 0.79 |
● Fazekas 2, grade | 4 (5.4%) | 6 (9.7%) | |
● Fazekas 3, grade | 3 (4%) | 2 (3.2%) | |
MMSE, score | 29 (27–29.5) | 29 (28–30) | 0.08 |
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Wieczorek, J.; Mizia-Stec, K.; Lasek-Bal, A.; Wieczorek, P.; Woźniak-Skowerska, I.; Wnuk-Wojnar, A.M.; Szydło, K. Hyperintense Brain Lesions in Asymptomatic Low Risk Patients with Paroxysmal Atrial Fibrillation Undergoing Radiofrequency Pulmonary Vein Isolation. J. Clin. Med. 2021, 10, 565. https://doi.org/10.3390/jcm10040565
Wieczorek J, Mizia-Stec K, Lasek-Bal A, Wieczorek P, Woźniak-Skowerska I, Wnuk-Wojnar AM, Szydło K. Hyperintense Brain Lesions in Asymptomatic Low Risk Patients with Paroxysmal Atrial Fibrillation Undergoing Radiofrequency Pulmonary Vein Isolation. Journal of Clinical Medicine. 2021; 10(4):565. https://doi.org/10.3390/jcm10040565
Chicago/Turabian StyleWieczorek, Joanna, Katarzyna Mizia-Stec, Anetta Lasek-Bal, Piotr Wieczorek, Iwona Woźniak-Skowerska, Anna M. Wnuk-Wojnar, and Krzysztof Szydło. 2021. "Hyperintense Brain Lesions in Asymptomatic Low Risk Patients with Paroxysmal Atrial Fibrillation Undergoing Radiofrequency Pulmonary Vein Isolation" Journal of Clinical Medicine 10, no. 4: 565. https://doi.org/10.3390/jcm10040565