Martina Piefke*, Lena Goldschmidt, Marc Horlitz, Buelent Koektuerk and Martin Bansmann
Objectives: In this study, we aimed at investigating putative neuropsychological long term impairments of cognitive flexibility, verbal long term memory, and theory of mind in patients with atrial fibrillation depending on frontal silent cerebral lesions 6-9 years after pulmonary vein isolation with a pulmonary vein ablation catheter. Background: The pulmonary vein ablation catheter (PVAC) shows an increased prevalence of developing silent cerebral lesions after pulmonary vein isolation in patients with atrial fibrillation. Methods: 20 participants were medically and neuropsychologically examined and underwent MRI of the brain. Results: Most lesions were located in the frontal lobes. Largeness of frontal lesions positively correlated with poorer verbal memory performance. Moreover, selective impairments of executive functions were associated with the extent of lesions. Symptom severity of atrial fibrillation correlated positively with impaired executive functions. Negative correlations were found between the risk of stroke and both executive functions and theory of mind. Conclusion: These data demonstrate for the first time evidence for specific persisting long term impairments in verbal memory and selective executive functions related to silent cerebral lesions in the frontal lobes in patients with atrial fibrillation 6-9 years after ablation with a PVAC catheter. We propose that MRI and comprehensive neuropsychological assessment should be accomplished in clinical routines before, immediately after and at different follow up time points. Such longitudinal assessment may help to better understand the incidence and development of silent cerebral lesions and thus predict the risk of persisting cognitive disturbances in patients with atrial fibrillation treated with PVAC PVI and other pulmonary vein isolation methods.
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