Silent Cerebral Infarction in Patients With Nonrheumatic Atrial Fibrillation

Ezekowitz, Michael D.; James, Kenneth E.; Nazarian, Sarkis M.; Davenport, John; Broderick, Joseph P.; Gupta, Simran; Thadani, Vijay M.; Meyer, Mark; Bridgers, Samuel L.

doi:10.1161/01.cir.92.8.2178

Cited by 221 publications

(68 citation statements)

References 15 publications

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“…1 Anticoagulant therapy has been shown to reduce this risk, although thromboembolic events, either symptomatic or silent, may occur even during antithrombotic treatment (1.2% and 14.7%, respectively). 12,13 In recent years, radiofrequency catheter ablation has evolved as an effective nonpharmacological treatment for AF. The main objective of the therapy is not only to improve symptoms but also to maintain sinus rhythm with the hope of reducing the incidence of thromboembolism.…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency Catheter Ablation of Atrial Fibrillation: A Cause of Silent Thromboembolism?

et al. 2010

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Background-Radiofrequency left atrial catheter ablation has become a routine procedure for treatment of atrial fibrillation. The aim of this study was to assess with preprocedural and postprocedural cerebral magnetic resonance imaging the thromboembolic risk, either silent or clinically manifest, in the context of atrial fibrillation ablation. The secondary end point was the identification of clinical or procedural parameters that correlate with cerebral embolism. Methods and Results-A total of 232 consecutive patients with paroxysmal or persistent atrial fibrillation who were candidates for radiofrequency left atrial catheter ablation were included in the study. Pulmonary vein isolation or pulmonary vein isolation plus linear lesions plus atrial defragmentation with the use of irrigated-tip ablation catheters was performed. All of the patients underwent preprocedural and postablation cerebral magnetic resonance imaging. A periprocedural symptomatic cerebrovascular accident occurred in 1 patient (0.4%). Postprocedural cerebral magnetic resonance imaging was positive for new embolic lesions in 33 patients (14%). No clinical parameters such as age, hypertension, diabetes mellitus, previous history of stroke, type of atrial fibrillation, and preablation antithrombotic treatment showed significant correlation with ischemic cerebral embolism. Procedural parameters such as activated clotting time value and, in particular, electric or pharmacological cardioversion to sinus rhythm correlated with an increased incidence of cerebral embolism. Cardioversion was also associated with an increased risk of 2.75 (95% confidence interval, 1.29 to 5.89; Pϭ0.009). Conclusions-Radiofrequency left atrial catheter ablation carries a low risk of symptomatic cerebral ischemia but is associated with a substantial risk of silent cerebral ischemia detected on magnetic resonance imaging. Independent risk factors for cerebral thromboembolism are the level of activated clotting time and, in particular, the electric or pharmacological cardioversion to sinus rhythm during the procedure. (Circulation. 2010;122:1667-1673.)

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Section: Discussionmentioning

confidence: 99%

Radiofrequency Catheter Ablation of Atrial Fibrillation: A Cause of Silent Thromboembolism?

et al. 2010

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“…[1][2][3][4][5] The reported prevalence of silent lesions observed by MRI varies, 3,[6][7][8][9] but there is consensus that it is high in elderly subjects and in patients with risk factors for stroke (eg, hypertension and atrial fibrillation (AF)). 1,4,10,11 The importance of these silent lesions has been emphasized in reports linking them to impaired cognition 2 and depression. 12 Furthermore, silent infarctions are considered a risk factor for symptomatic infarction and brain hemorrhage.…”

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confidence: 99%

“…[17][18][19][20][21] However, a large, well-designed study carried out by the SPINAF group did not show a significant effect of aspirin on the annual event rate of silent BI. 11 That study used computed tomography (CT) to detect the silent lesions, which may explain why the event rate (1.01%/year in the placebo group and 1.57%/year in the warfarin group) was relatively low. We used MRI, which is more sensitive than CT and more accurately detects small ischemic foci, to screen patients with NVAF.…”

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confidence: 99%

Aspirin Attenuates the Incidence of Silent Brain Lesions in Patients With Nonvalvular Atrial Fibrillation

Sato

Koretsune

Fukunami³

et al. 2004

Circ J

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Background Abnormal findings, including silent cerebral infarction, are frequently observed by magnetic resonance imaging (MRI) in patients with nonvalvular atrial fibrillation (NVAF); however, the prevalence and prevention strategy for these lesions have not been extensively studied. In the present study the preventive effects of aspirin on silent ischemic lesions was investigated. Methods and Results Silent lesions were counted using cranial MRI performed in 78 neurologically normal adults with sinus rhythm and in 212 patients with NVAF without a history of stroke. MRIs were repeated twice in the NVAF patients at 12-month intervals. During the first year, patients received neither antiplatelet agent nor anticoagulant; in the second year, aspirin (330 mg daily) was administered. The prevalence of lesions in the initial MRI was higher in NVAF patients (86.4%) than in sinus rhythm subjects (53.8%; p<0.001). After 12 months without aspirin, new lesions were seen in 20.6% of NVAF patients. The yearly occurrence of new lesions was decreased to 9.6% during the year of treatment with aspirin (p=0.014). Conclusions In patients with NVAF, abnormal lesions are frequently observed by MRI and aspirin treatment may be effective in preventing further small silent lesions. (Circ J 2004; 68: 410 -416)

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“…Criteria for diagnosis of Diabetes mellitus [6] (type II): • Symptoms of diabetes plus random blood glucose concentration > 200 mg/dl or • Fasting plasma glucose > 126 mg/dl or • HbA1C > 6.5% or • Two hour plasma glucose >200 mg/dl during an oral glucose tolerance test Exclusion criteria: includes, previous stroke, any other metabolic conditions to be excluded (i.e. Diabetes complicated by renal failure).…”

Section: Methodsmentioning

confidence: 99%

“…They were first described by Fisher [6] in a cohort of 114 subjects who came to autopsy; 88 brains had at least 1 lacune in the absence of clinical deficits or a stroke history. In recent studies, the prevalence of SCI on MRI scans has ranged from 5.84% to 28%.…”

Section: Introductionmentioning

confidence: 99%

Silent Cerebral Infarctions in Type II Diabetes Mellitus Patients; Could Brain MRI Be a Routine Investigation?

Ibrahim¹,

Alloush²,

Shaaban³

et al. 2014

OJMI

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Objective: To study the prevalence of silent cerebral infarction in Type II diabetes mellitus. Patients and Methods: The study was a prospective on 80 patients recruited from neurology, endocrine outpatient clinics. Patients were type II diabetics as described by the American Diabetes Association, 2011 criteria. All patients underwent full metabolic profiles to diagnose diabetes mellitus and MRI brain scans to detect cerebral infarction. Results: Silent cerebral infarctions were detected in 60% of patients (48/80 patients) predominately along periventricular white matter area and subcortical areas (Basal ganglia, Thalamus). Conclusion: Asymptomatic Type II diabetes mellitus patients could have vascular cerebral changes without neurological symptoms. MRI brain scans could be recommended as routine diagnosis (if possible) for early cerebral infarct detection in type II diabetic patients.

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Silent Cerebral Infarction in Patients With Nonrheumatic Atrial Fibrillation

Cited by 221 publications

References 15 publications

Radiofrequency Catheter Ablation of Atrial Fibrillation: A Cause of Silent Thromboembolism?

Radiofrequency Catheter Ablation of Atrial Fibrillation: A Cause of Silent Thromboembolism?

Aspirin Attenuates the Incidence of Silent Brain Lesions in Patients With Nonvalvular Atrial Fibrillation

Silent Cerebral Infarctions in Type II Diabetes Mellitus Patients; Could Brain MRI Be a Routine Investigation?

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