TY - JOUR
T1 - Does periprocedural anticoagulation management of atrial fibrillation affect the prevalence of silent thromboembolic lesion detected by diffusion cerebral magnetic resonance imaging in patients undergoing radiofrequency atrial fibrillation ablation with open irrigated catheters? Results from a prospective multicenter study
AU - Di Biase, Luigi
AU - Gaita, Fiorenzo
AU - Toso, Elisabetta
AU - Santangeli, Pasquale
AU - Mohanty, Prasant
AU - Rutledge, Neal
AU - Yan, Xue
AU - Mohanty, Sanghamitra
AU - Trivedi, Chintan
AU - Bai, Rong
AU - Price, Justin
AU - Horton, Rodney
AU - Gallinghouse, G. Joseph
AU - Beheiry, Salwa
AU - Zagrodzky, Jason
AU - Canby, Robert
AU - Leclercq, Jean François
AU - Halimi, Franck
AU - Scaglione, Marco
AU - Cesarani, Federico
AU - Faletti, Riccardo
AU - Sanchez, Javier
AU - Burkhardt, J. David
AU - Natale, Andrea
N1 - Funding Information:
This study was partially funded by a grant from Biosense Webster. Dr. Di Biase serves as a consultant for Hansen Medical, Biosense Webster, and St. Jude Medical, and has received speaker honoraria from Biotronik and Atricure. Dr. Gallinghouse is a consultant for Hansen Medical. Dr. Natale has received honoraria to the speakers’ bureau from St. Jude Medical, Boston Scientific, Medtronic, and Biosense Webster, and is a consultant for Biosense Webster, St. Jude Medical, and Janssen.
PY - 2014/5
Y1 - 2014/5
N2 - Background Silent cerebral ischemia (SCI) has been reported in 14% of cases after catheter ablation of atrial fibrillation (AF) with radiofrequency (RF) energy and discontinuation of warfarin before AF ablation procedures. Objective The purpose of this study was to determine whether periprocedural anticoagulation management affects the incidence of SCI after RF ablation using an open irrigated catheter. Methods Consecutive patients undergoing RF ablation for AF without warfarin discontinuation and receiving heparin bolus before transseptal catheterization (group I, n = 146) were compared with a group of patients who had protocol deviation in terms of maintaining the therapeutic preprocedural international normalized ratio (patients with subtherapeutic INR) and/or failure to receive pretransseptal heparin bolus infusion and/or >2 consecutive ACT measurements <300 seconds (noncompliant population, group II, n = 134) and with a group of patients undergoing RF ablation with warfarin discontinuation bridged with low molecular weight heparin (group III, n = 148). All patients underwent preablation and postablation (within 48 hours) diffusion magnetic resonance imaging. Results SCI was detected in 2% of patients (3/146) in group I, 7% (10/134) in group II, and 14% (21/148) in group III (P <.001). "Therapeutic INR" was strongly associated with a lower prevalence of postprocedural silent cerebral ischemia (SCI). Multivariable analysis demonstrated nonparoxysmal AF (odds ratio 3.8, 95% confidence interval 1.5-9.7, P =.005) and noncompliance to protocol (odds ratio 2.8, 95% confidence interval 1.5-5.1, P <.001] to be significant predictors of ischemic events. Conclusion Strict adherence to an anticoagulation protocol significantly reduces the prevalence of SCI after catheter ablation of AF with RF energy.
AB - Background Silent cerebral ischemia (SCI) has been reported in 14% of cases after catheter ablation of atrial fibrillation (AF) with radiofrequency (RF) energy and discontinuation of warfarin before AF ablation procedures. Objective The purpose of this study was to determine whether periprocedural anticoagulation management affects the incidence of SCI after RF ablation using an open irrigated catheter. Methods Consecutive patients undergoing RF ablation for AF without warfarin discontinuation and receiving heparin bolus before transseptal catheterization (group I, n = 146) were compared with a group of patients who had protocol deviation in terms of maintaining the therapeutic preprocedural international normalized ratio (patients with subtherapeutic INR) and/or failure to receive pretransseptal heparin bolus infusion and/or >2 consecutive ACT measurements <300 seconds (noncompliant population, group II, n = 134) and with a group of patients undergoing RF ablation with warfarin discontinuation bridged with low molecular weight heparin (group III, n = 148). All patients underwent preablation and postablation (within 48 hours) diffusion magnetic resonance imaging. Results SCI was detected in 2% of patients (3/146) in group I, 7% (10/134) in group II, and 14% (21/148) in group III (P <.001). "Therapeutic INR" was strongly associated with a lower prevalence of postprocedural silent cerebral ischemia (SCI). Multivariable analysis demonstrated nonparoxysmal AF (odds ratio 3.8, 95% confidence interval 1.5-9.7, P =.005) and noncompliance to protocol (odds ratio 2.8, 95% confidence interval 1.5-5.1, P <.001] to be significant predictors of ischemic events. Conclusion Strict adherence to an anticoagulation protocol significantly reduces the prevalence of SCI after catheter ablation of AF with RF energy.
KW - Ablation
KW - Atrial fibrillation
KW - Periprocedural
KW - Radiofrequency
KW - Silent cerebral ischemia
KW - Stroke
KW - Warfarin
UR - http://www.scopus.com/inward/record.url?scp=84898932277&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84898932277&partnerID=8YFLogxK
U2 - 10.1016/j.hrthm.2014.03.003
DO - 10.1016/j.hrthm.2014.03.003
M3 - Article
C2 - 24607716
AN - SCOPUS:84898932277
SN - 1547-5271
VL - 11
SP - 791
EP - 798
JO - Heart Rhythm
JF - Heart Rhythm
IS - 5
ER -