Risk Factors and Localization of Silent Cerebral Infarction in Patients with Atrial Fibrillation

Abstract Background It is important to identify the risk factors and localization of silent cerebral infarction (SCI), especially in younger patients with atrial fibrillation (AF). Objectives The purpose of this study was to address these important issues. Methods We enrolled 286 consecutive neurologically asymptomatic patients who underwent AF ablation from January 2014 to July 2017 (61.7±10.2 [SD] years-old, male/female 208/78). Before ablation, all patients underwent magnetic resonance imaging (MRI). Results SCIs were classified independently by 2 radiologists as follows; cardiogenic SCI in 19 (10.6%), lacunar SCI in 13 (8.9%), undetermined causes in 6 (1.6%), and no SCI in 248 (controls, 78.7%). Importantly, no patients with CHA 2 DS 2 -VASc score 0 had SCI on MRI. In univariable analysis, significant risk factors for lacunar SCI included age (P=0.007), hypertension (P=0.037), congestive heart failure (P=0.040), left atrial (LA) diameter (P=0.013), and cardio-ankle vascular index (P=0.004). In multivariable analysis, significant risk factors for cardiogenic SCI were AF duration (OR 1.01, 95% CI 1.00-1.02; P=0.038), ankle-brachial pressure index (OR 0.002, 95% CI 0-0.68; P=0.030), and LA abnormality (OR 8.99, 95% CI 2.78-31.00; P Conclusions These results indicate that among AF patients, SCI localized in the cerebral cortex and cerebellum is frequently noted, for which cardiogenic mechanisms may be mainly involved, that CHA 2 DS 2 -VASc score could be useful for screening SCI, and that LA abnormality is the specific marker for cardiogenic SCI, providing useful information for risk stratification of SCI.