Background Silent cerebral infarction (SCI) is a frequent perioperative complication of catheter ablation for atrial fibrillation (AF), yet its detection currently relies on magnetic resonance imaging (MRI) — a modality not routinely accessible for all patients. This preliminary study investigated whether neuron-specific enolase (NSE), a serum biomarker of neuronal injury, could serve as a practical screening tool for perioperative SCI following radiofrequency ablation for AF. Methods This exploratory study enrolled 97 patients undergoing first-time radiofrequency catheter ablation for AF. Based on MRI performed 24–48 h post-procedure, patients were classified into the SCI and non-SCI groups. Serum NSE levels were measured before ablation (NSEpre), immediately after ablation (NSEipost), and 24 h post-ablation (NSE24h post). Multivariate logistic regression, receiver operating characteristic (ROC) curve analysis, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were employed to assess the association between NSE and SCI. Results Among the 97 patients (63 paroxysmal AF, 34 persistent AF), SCI was detected in 15 patients (15.5%). In the overall cohort, serum NSE levels increased significantly immediately after ablation compared with baseline and remained elevated at 24 h post-procedure (both P < 0.001). NSEipost levels were significantly higher in the SCI group than in the non-SCI group (P = 0.034), whereas NSEpre levels were comparable between groups. Multivariate logistic regression identified a greater increase in NSE from pre- to immediate post-ablation (ΔNSEipost–pre) as significantly associated with SCI (OR = 1.31, 95%CI 1.09–1.62, P = 0.016). ROC analysis revealed that ΔNSEipost–pre, with an optimal cutoff value of 4.6 ng/mL, yielded a sensitivity of 93.3%, a specificity of 39.0%, and an area under the curve of 0.69 for detecting SCI. Incorporating ΔNSEipost–pre significantly improved the model’s discriminative performance (NRI = 0.748, 95% CI 0.232–1.064, P < 0.001; IDI = 0.084, 95% CI 0.024–0.114, P = 0.003). Conclusion Serum NSE exhibits high sensitivity for detecting SCI following AF ablation, suggesting its potential as a post-procedural screening tool to help identify patients who may benefit from confirmatory MRI, particularly in resource-constrained settings. Given the exploratory nature of this study and its methodological limitations, these findings should be considered hypothesis-generating and warrant validation in larger, well-designed prospective cohorts.

The potential value of serum neuron-specific enolase in screening for silent cerebral infarction following radiofrequency catheter ablation for atrial fibrillation

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2026年4月30日

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Beibei Gao,
Liqi Ge,
Xudong Zhao,
Chunqing Wang,
Zhongxiao Liu,
Dandan Zuo,
Fei Li,
Chaoqun Zhang

摘要

Background

Silent cerebral infarction (SCI) is a frequent perioperative complication of catheter ablation for atrial fibrillation (AF), yet its detection currently relies on magnetic resonance imaging (MRI) — a modality not routinely accessible for all patients. This preliminary study investigated whether neuron-specific enolase (NSE), a serum biomarker of neuronal injury, could serve as a practical screening tool for perioperative SCI following radiofrequency ablation for AF.

Methods

This exploratory study enrolled 97 patients undergoing first-time radiofrequency catheter ablation for AF. Based on MRI performed 24–48 h post-procedure, patients were classified into the SCI and non-SCI groups. Serum NSE levels were measured before ablation (NSE_pre), immediately after ablation (NSE_ipost), and 24 h post-ablation (NSE_{24h post}). Multivariate logistic regression, receiver operating characteristic (ROC) curve analysis, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were employed to assess the association between NSE and SCI.

Results

Among the 97 patients (63 paroxysmal AF, 34 persistent AF), SCI was detected in 15 patients (15.5%). In the overall cohort, serum NSE levels increased significantly immediately after ablation compared with baseline and remained elevated at 24 h post-procedure (both P < 0.001). NSE_ipost levels were significantly higher in the SCI group than in the non-SCI group (P = 0.034), whereas NSE_pre levels were comparable between groups. Multivariate logistic regression identified a greater increase in NSE from pre- to immediate post-ablation (ΔNSE_ipost–pre) as significantly associated with SCI (OR = 1.31, 95%CI 1.09–1.62, P = 0.016). ROC analysis revealed that ΔNSE_ipost–pre, with an optimal cutoff value of 4.6 ng/mL, yielded a sensitivity of 93.3%, a specificity of 39.0%, and an area under the curve of 0.69 for detecting SCI. Incorporating ΔNSE_ipost–pre significantly improved the model’s discriminative performance (NRI = 0.748, 95% CI 0.232–1.064, P < 0.001; IDI = 0.084, 95% CI 0.024–0.114, P = 0.003).

Conclusion

Serum NSE exhibits high sensitivity for detecting SCI following AF ablation, suggesting its potential as a post-procedural screening tool to help identify patients who may benefit from confirmatory MRI, particularly in resource-constrained settings. Given the exploratory nature of this study and its methodological limitations, these findings should be considered hypothesis-generating and warrant validation in larger, well-designed prospective cohorts.