MRI-detected brain lesions in AF patients without further stroke risk factors undergoing ablation - a retrospective analysis of prospective studies

Research output: Contribution to journalArticlepeer-review


  • Juliane Herm
  • Johannes Schurig
  • Martin R Martinek
  • Reinhard Höltgen
  • Alexander Schirdewan
  • Marcus Wieczorek
  • Helmut Pürerfellner
  • Peter U Heuschmann
  • Jochen B Fiebach
  • Karl Georg Haeusler

Colleges, School and Institutes

External organisations

  • Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
  • Department of Cardiology, Ordensklinikum Linz Elisabethinen, Linz, Austria.
  • Department of Cardiology and Electrophysiology, St. Agnes-Hospital Bocholt, Bocholt, Germany.
  • Department of Cardiology, Sana Clinic Lichtenberg, Berlin, Germany.
  • Witten/Herdecke University, School of Medicine, Witten, Germany.
  • Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.
  • Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
  • Department of Neurology, Universitätsklinikum Würzburg, Josef-Schneider-Str. 11 97080, Würzburg, Germany.


BACKGROUND: Atrial fibrillation (AF) without other stroke risk factors is assumed to have a low annual stroke risk comparable to patients without AF. Therefore, current clinical guidelines do not recommend oral anticoagulation for stroke prevention of AF in patients without stroke risk factors. We analyzed brain magnetic resonance imaging (MRI) imaging to estimate the rate of clinically inapparent ("silent") ischemic brain lesions in these patients.

METHODS: We pooled individual patient-level data from three prospective studies comprising stroke-free patients with symptomatic AF. All study patients underwent brain MRI within 24-48 h before planned left atrial catheter ablation. MRIs were analyzed by a neuroradiologist blinded to clinical data.

RESULTS: In total, 175 patients (median age 60 (IQR 54-67) years, 32% female, median CHA2DS2-VASc = 1 (IQR 0-2), 33% persistent AF) were included. In AF patients without or with at least one stroke risk factor, at least one silent ischemic brain lesion was observed in 4 (8%) out of 48 and 10 (8%) out of 127 patients, respectively (p > 0.99). Presence of silent ischemic brain lesions was related to age (p = 0.03) but not to AF pattern (p = 0.77). At least one cerebral microbleed was detected in 5 (13%) out of 30 AF patients without stroke risk factors and 25 (25%) out of 108 AF patients with stroke risk factors (p = 0.2). Presence of cerebral microbleeds was related to male sex (p = 0.04) or peripheral artery occlusive disease (p = 0.03).

CONCLUSION: In patients with symptomatic AF scheduled for ablation, brain MRI detected silent ischemic brain lesions in approximately one in 12 patients, and microbleeds in one in 5 patients. The prevalence of silent ischemic brain lesions did not differ in AF patients with or without further stroke risk factors.


Original languageEnglish
Article number58
Number of pages8
JournalBMC Cardiovascular Disorders
Issue number1
Publication statusPublished - 12 Mar 2019


  • Clinically silent stroke, atrial fibrillation, magnetic resonance imaging, cerebral microbleeds