Postablation asymptomatic cerebral lesions: long-term follow-up using magnetic resonance imaging

Heart Rhythm. 2011 Nov;8(11):1705-11. doi: 10.1016/j.hrthm.2011.06.030. Epub 2011 Jul 2.


Background: Catheter ablation of atrial fibrillation (AF) is complicated by cerebral emboli resulting in acute ischemia. Recently, cerebral ischemic microlesions have been identified with diffusion-weighted magnet resonance imaging (MRI).

Objective: The clinical course and longer-term characteristics of these lesions are not known and were investigated in this study.

Methods: Of 86 patients, 33 (38%) had new asymptomatic cerebral lesions documented on MRI after catheter ablation for AF; 14 of these 33 (42%) underwent repeat MRI at different time intervals (2 weeks to 1 year) during follow-up, and clinical symptoms as well as size and number of residual lesions were documented.

Results: In postablation cerebral MRI, 50 new lesions were identified (3.6 lesions/patient) in 14 patients. No patient presented any neurological symptoms. Distribution of the lesions was predominantly in the left hemisphere (60%) and the cerebellum (26%); 52% of the lesions were small (≤3 mm maximum diameter), 42% were medium (4 to 10 mm) and 3 lesions (6%) had a maximum diameter >10 mm. Follow-up MRI after a median of 3 months revealed 3 residual lesions in 3 of 14 patients corresponding to the large acute postablation lesions (>10 mm). The remaining 47 of 50 (94%) of the small or medium-sized lesions were not detectable at follow-up evaluation.

Conclusions: Most asymptomatic cerebral lesions observed acutely after AF ablation procedures were ≤10 mm in diameter. 94% of all lesions healed without scarring at follow-up >2 weeks after ablation. The larger acute lesions produced chronic glial scars. Neither chronic nor acute lesions were associated with neurological symptoms.

Publication types

  • Comparative Study

MeSH terms

  • Atrial Fibrillation / surgery*
  • Catheter Ablation / adverse effects*
  • Diagnosis, Differential
  • Female
  • Follow-Up Studies
  • Humans
  • Intracranial Embolism / diagnosis*
  • Intracranial Embolism / etiology
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Prognosis
  • Time Factors