{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T21:47:34Z","timestamp":1788990454637,"version":"build-2803163510"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2022,3,22]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>We aimed to assess the prevalence of ischemic brain lesions detected by magnetic resonance imaging and their association with cognitive function 3 months after first-time ablation using continuous oral anticoagulation in patients with paroxysmal atrial fibrillation (AF).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>We performed a prespecified analysis of the AXAFA-AFNET 5 trial (Anticoagulation Using the Direct Factor Xa Inhibitor Apixaban During Atrial Fibrillation Catheter Ablation: Comparison to Vitamin K Antagonist Therapy), which randomized 674 patients with AF 1:1 to uninterrupted apixaban or vitamin K antagonist therapy before first-time ablation. Brain magnetic resonance imaging using fluid-attenuated inversion recovery and high-resolution diffusion-weighted imaging was obtained within 3 to 48 hours after AF ablation in all eligible patients enrolled in 25 study centers in Europe and the United States. Patients underwent cognitive assessment 3 to 6 weeks before ablation and 3 months after ablation using the Montreal Cognitive Assessment (MoCA).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              In 84 (26.1%) of 321 patients with analyzable magnetic resonance imaging, high-resolution diffusion-weighted imaging detected at least 1 acute brain lesion, including 44 (27.2%) patients treated with apixaban and 40 (24.8%) patients treated with vitamin K antagonist (\n              <jats:italic>P<\/jats:italic>\n              =0.675). Median MoCA score was similar in patients with or without acute brain lesions at 3 months after ablation (28 [interquartile range (IQR), 26\u201329] versus 28 [IQR, 26\u201329];\n              <jats:italic>P<\/jats:italic>\n              =0.948). Cerebral chronic white matter damage (defined as Wahlund score \u22654 points) detected by fluid-attenuated inversion recovery was present in 130 (40.5%) patients and associated with lower median MoCA scores before ablation (27 [IQR, 24\u201328] versus 27 [IQR, 25\u201329];\n              <jats:italic>P<\/jats:italic>\n              =0.026) and 3 months after ablation (27 [IQR, 25\u201329] versus 28 [IQR, 26\u201329];\n              <jats:italic>P<\/jats:italic>\n              =0.011). This association was no longer significant when adjusted for age and sex. Age was associated with lower MoCA scores before ablation (relative risk, 1.02 per 10 years [95% CI, 1.01\u20131.03]) and 3 months after ablation (relative risk, 1.02 per 10 years [95% CI, 1.01\u20131.03]).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Chronic white matter damage as well as acute ischemic lesions detected by brain magnetic resonance imaging were found frequently after first-time ablation for paroxysmal AF using uninterrupted oral anticoagulation. Acute ischemic brain lesions detected by high-resolution diffusion-weighted imaging were not associated with cognitive function at 3 months after ablation. Lower MoCA scores before and after ablation were associated only with older age, highlighting the safety of AF ablation on uninterrupted oral anticoagulation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Registration:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT02227550.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.121.056320","type":"journal-article","created":{"date-parts":[[2022,2,9]],"date-time":"2022-02-09T10:01:29Z","timestamp":1644400889000},"page":"906-915","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":38,"title":["MRI-Detected Brain Lesions and Cognitive Function in Patients With Atrial Fibrillation Undergoing Left Atrial Catheter Ablation in the Randomized AXAFA-AFNET 5 Trial"],"prefix":"10.1161","volume":"145","clinical-trial-number":[{"clinical-trial-number":"nct02227550","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6389-5054","authenticated-orcid":true,"given":"Karl Georg","family":"Haeusler","sequence":"first","affiliation":[{"name":"Atrial Fibrillation Network (AFNET), M\u00fcnster, Germany (K.G.H., B.B., U.S., P.K.)."},{"name":"Department of Neurology, Universit\u00e4tsklinikum W\u00fcrzburg, Germany (K.G.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5415-0456","authenticated-orcid":true,"given":"Felizitas A.","family":"Eichner","sequence":"additional","affiliation":[{"name":"Institute of Clinical Epidemiology and Biometry, University W\u00fcrzburg, Germany (F.A.E., P.U.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2681-3515","authenticated-orcid":true,"given":"Peter U.","family":"Heuschmann","sequence":"additional","affiliation":[{"name":"Institute of Clinical Epidemiology and Biometry, University W\u00fcrzburg, Germany (F.A.E., P.U.H.)."},{"name":"Clinical Trial Center, University Hospital W\u00fcrzburg, Germany (P.U.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7936-6958","authenticated-orcid":true,"given":"Jochen B.","family":"Fiebach","sequence":"additional","affiliation":[{"name":"Center for Stroke Research Berlin, Charit\u00e9-Universit\u00e4tsmedizin Berlin, Germany (J.B.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Engelhorn","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany (T.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6134-1085","authenticated-orcid":true,"given":"Benjamin","family":"Blank","sequence":"additional","affiliation":[{"name":"Atrial Fibrillation Network (AFNET), M\u00fcnster, Germany (K.G.H., B.B., U.S., P.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6823-6149","authenticated-orcid":true,"given":"David","family":"Callans","sequence":"additional","affiliation":[{"name":"Hospital of the University of Pennsylvania, Philadelphia (D.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8436-8635","authenticated-orcid":true,"given":"Arif","family":"Elvan","sequence":"additional","affiliation":[{"name":"Isala Heart Center, Zwolle, The Netherlands (A.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Grimaldi","sequence":"additional","affiliation":[{"name":"Ospedale Generale Regionale F. Miulli, Acquaviva delle Fonti, Italy (M.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jim","family":"Hansen","sequence":"additional","affiliation":[{"name":"Gentofte Hospital, Hellerup, Denmark (J.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerhard","family":"Hindricks","sequence":"additional","affiliation":[{"name":"Abteilung f\u00fcr Rhythmologie, Leipzig Heart Center, Germany (G.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1375-0487","authenticated-orcid":true,"given":"Hussein R.","family":"Al-Khalidi","sequence":"additional","affiliation":[{"name":"Department of Biostatistics &amp; Bioinformatics, Duke University School of Medicine, Durham, NC (H.R.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8115-5906","authenticated-orcid":true,"given":"Lluis","family":"Mont","sequence":"additional","affiliation":[{"name":"Hospital Clinic Barcelona, University of Barcelona, Spain (L.M.)."},{"name":"Institut de Recerca Biom\u00e8dica August Pi Sunyer (IDIBAPS), Barcelona, Spain (L.M.)."},{"name":"CIBER Cardiovascular, Madrid, Spain (L.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9414-1653","authenticated-orcid":true,"given":"Jens Cosedis","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0772-2404","authenticated-orcid":true,"given":"Jonathan P.","family":"Piccini","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute (DCRI), Durham, NC (J.P.P.)."},{"name":"Division of Cardiology, Duke University Medical Center, Durham, NC (J.P.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1532-3315","authenticated-orcid":true,"given":"Ulrich","family":"Schotten","sequence":"additional","affiliation":[{"name":"Atrial Fibrillation Network (AFNET), M\u00fcnster, Germany (K.G.H., B.B., U.S., P.K.)."},{"name":"Department of Physiology, University Maastricht, The Netherlands (U.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7998-7113","authenticated-orcid":true,"given":"Sakis","family":"Themistoclakis","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Ospedale Dell\u2019Angelo, Mestre-Venice, Italy (S.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4928-4836","authenticated-orcid":true,"given":"Johan","family":"Vijgen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Jessa Hospitals, Hasselt, Belgium (J.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6508-4047","authenticated-orcid":true,"given":"Luigi","family":"Di Biase","sequence":"additional","affiliation":[{"name":"Albert Einstein College of Medicine at Montefiore Hospital, New York (L.D.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1881-0197","authenticated-orcid":true,"given":"Paulus","family":"Kirchhof","sequence":"additional","affiliation":[{"name":"Atrial Fibrillation Network (AFNET), M\u00fcnster, Germany (K.G.H., B.B., U.S., P.K.)."},{"name":"University of Birmingham Institute of Cardiovascular Sciences, UK (P.K.)."},{"name":"Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Germany (P.K.)."},{"name":"German Center for Cardiovascular Research (DZHK), partner site Hamburg\/Kiel\/L\u00fcbeck, Germany (P.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa612"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2017.05.012"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2019422"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz782"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.050991"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.627067"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy176"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz190"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.113.000174"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eux031"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1701005"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv177"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euw368"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2005.53221.x"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.32.6.1318"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.04.034"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2019.03.036"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2014.03.003"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.121.056320","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T07:52:10Z","timestamp":1715586730000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.121.056320"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,22]]},"references-count":18,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2022,3,22]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.121.056320"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.121.056320","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,22]]},"assertion":[{"value":"2021-06-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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