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

Luigi Di Biase, Fiorenzo Gaita, Elisabetta Toso, Pasquale Santangeli, Prasant Mohanty, Neal Rutledge, Xue Yan, Sanghamitra Mohanty, Chintan Trivedi, Rong Bai, Justin Price, Rodney Horton, G. Joseph Gallinghouse, Salwa Beheiry, Jason Zagrodzky, Robert Canby, Jean François Leclercq, Franck Halimi, Marco Scaglione, Federico Cesarani & 4 others Riccardo Faletti, Javier Sanchez, J. David Burkhardt, Andrea Natale

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)791-798
Number of pages8
JournalHeart Rhythm
Volume11
Issue number5
DOIs
StatePublished - 2014

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Diffusion Magnetic Resonance Imaging
Atrial Fibrillation
Multicenter Studies
Brain Ischemia
Catheters
Prospective Studies
International Normalized Ratio
Warfarin
Catheter Ablation
Heparin
Odds Ratio
Confidence Intervals
Low Molecular Weight Heparin
Population Groups
Catheterization
Incidence
Therapeutics

Keywords

  • Ablation
  • Atrial fibrillation
  • Periprocedural
  • Radiofrequency
  • Silent cerebral ischemia
  • Stroke
  • Warfarin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

Cite this

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. / Di Biase, Luigi; Gaita, Fiorenzo; Toso, Elisabetta; Santangeli, Pasquale; Mohanty, Prasant; Rutledge, Neal; Yan, Xue; Mohanty, Sanghamitra; Trivedi, Chintan; Bai, Rong; Price, Justin; Horton, Rodney; Gallinghouse, G. Joseph; Beheiry, Salwa; Zagrodzky, Jason; Canby, Robert; Leclercq, Jean François; Halimi, Franck; Scaglione, Marco; Cesarani, Federico; Faletti, Riccardo; Sanchez, Javier; Burkhardt, J. David; Natale, Andrea.

In: Heart Rhythm, Vol. 11, No. 5, 2014, p. 791-798.

Research output: Contribution to journalArticle

Di Biase, L, Gaita, F, Toso, E, Santangeli, P, Mohanty, P, Rutledge, N, Yan, X, Mohanty, S, Trivedi, C, Bai, R, Price, J, Horton, R, Gallinghouse, GJ, Beheiry, S, Zagrodzky, J, Canby, R, Leclercq, JF, Halimi, F, Scaglione, M, Cesarani, F, Faletti, R, Sanchez, J, Burkhardt, JD & Natale, A 2014, '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', Heart Rhythm, vol. 11, no. 5, pp. 791-798. https://doi.org/10.1016/j.hrthm.2014.03.003
Di Biase, Luigi ; Gaita, Fiorenzo ; Toso, Elisabetta ; Santangeli, Pasquale ; Mohanty, Prasant ; Rutledge, Neal ; Yan, Xue ; Mohanty, Sanghamitra ; Trivedi, Chintan ; Bai, Rong ; Price, Justin ; Horton, Rodney ; Gallinghouse, G. Joseph ; Beheiry, Salwa ; Zagrodzky, Jason ; Canby, Robert ; Leclercq, Jean François ; Halimi, Franck ; Scaglione, Marco ; Cesarani, Federico ; Faletti, Riccardo ; Sanchez, Javier ; Burkhardt, J. David ; Natale, Andrea. / 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. In: Heart Rhythm. 2014 ; Vol. 11, No. 5. pp. 791-798.
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abstract = "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.",
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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

PY - 2014

Y1 - 2014

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

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