Periprocedural stroke and management of major bleeding complications in patients undergoing catheter ablation of atrial fibrillation: The impact of periprocedural therapeutic international normalized ratio

Luigi Di Biase, J. David Burkhardt, Prasant Mohanty, Javier Sanchez, Rodney Horton, G. Joseph Gallinghouse, Dhanunjay Lakkireddy, Atul Verma, Yaariv Khaykin, Richard Hongo, Steven Hao, Salwa Beheiry, Gemma Pelargonio, Antonio Dello Russo, Michela Casella, Pietro Santarelli, Pasquale Santangeli, Paul Wang, Amin Al-Ahmad, Dimpi PatelSakis Themistoclakis, Aldo Bonso, Antonio Rossillo, Andrea Corrado, Antonio Raviele, Jennifer E. Cummings, Robert A. Schweikert, William R. Lewis, Andrea Natale

Research output: Contribution to journalArticle

227 Citations (Scopus)

Abstract

Background-Catheter ablation of atrial fibrillation is associated with the potential risk of periprocedural stroke, which can range between 1% and 5%. We developed a prospective database to evaluate the prevalence of stroke over time and to assess whether the periprocedural anticoagulation strategy and use of open irrigation ablation catheter have resulted in a reduction of this complication. Methods and Results-We collected data from 9 centers performing the same ablation procedure with the same anticoagulation protocol. We divided the patients into 3 groups: ablation with an 8-mm catheter off warfarin (group 1), ablation with an open irrigated catheter off warfarin (group 2), and ablation with an open irrigated catheter on warfarin (group 3). Outcome data on stroke/transient ischemic attack and bleeding complications during and early after the procedures were collected. Of 6454 consecutive patients in the study, 2488 were in group 1, 1348 were in group 2, and 2618 were in group 3. Periprocedural stroke/transient ischemic attack occurred in 27 patients (1.1%) in group 1 and 12 patients (0.9%) in group 2. Despite a higher prevalence of nonparoxysmal atrial fibrillation and more patients with CHADS2 (congestive heart failure, hypertension, age >75 years, diabetes mellitus, and prior stroke or transient ischemic attack) score >2, no stroke/transient ischemic attack was reported in group 3. Complications among groups 1, 2, and 3, including major bleeding (10 [0.4%], 11 [0.8%], and 10 [0.4%], respectively; P>0.05) and pericardial effusion (11 [0.4%], 11 [0.8%], and 12 [0.5%]; P>0.05), were equally distributed. Conclusion-The combination of an open irrigation ablation catheter and periprocedural therapeutic anticoagulation with warfarin may reduce the risk of periprocedural stroke without increasing the risk of pericardial effusion or other bleeding complications.

Original languageEnglish (US)
Pages (from-to)2550-2556
Number of pages7
JournalCirculation
Volume121
Issue number23
DOIs
StatePublished - Jun 15 2010
Externally publishedYes

Fingerprint

International Normalized Ratio
Catheter Ablation
Atrial Fibrillation
Stroke
Hemorrhage
Transient Ischemic Attack
Warfarin
Catheters
Pericardial Effusion
Therapeutics
Diabetes Mellitus
Heart Failure
Databases
Hypertension

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Embolism
  • Stroke
  • Transient ischemic attack
  • Warfarin

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Periprocedural stroke and management of major bleeding complications in patients undergoing catheter ablation of atrial fibrillation : The impact of periprocedural therapeutic international normalized ratio. / Di Biase, Luigi; Burkhardt, J. David; Mohanty, Prasant; Sanchez, Javier; Horton, Rodney; Gallinghouse, G. Joseph; Lakkireddy, Dhanunjay; Verma, Atul; Khaykin, Yaariv; Hongo, Richard; Hao, Steven; Beheiry, Salwa; Pelargonio, Gemma; Dello Russo, Antonio; Casella, Michela; Santarelli, Pietro; Santangeli, Pasquale; Wang, Paul; Al-Ahmad, Amin; Patel, Dimpi; Themistoclakis, Sakis; Bonso, Aldo; Rossillo, Antonio; Corrado, Andrea; Raviele, Antonio; Cummings, Jennifer E.; Schweikert, Robert A.; Lewis, William R.; Natale, Andrea.

In: Circulation, Vol. 121, No. 23, 15.06.2010, p. 2550-2556.

Research output: Contribution to journalArticle

Di Biase, L, Burkhardt, JD, Mohanty, P, Sanchez, J, Horton, R, Gallinghouse, GJ, Lakkireddy, D, Verma, A, Khaykin, Y, Hongo, R, Hao, S, Beheiry, S, Pelargonio, G, Dello Russo, A, Casella, M, Santarelli, P, Santangeli, P, Wang, P, Al-Ahmad, A, Patel, D, Themistoclakis, S, Bonso, A, Rossillo, A, Corrado, A, Raviele, A, Cummings, JE, Schweikert, RA, Lewis, WR & Natale, A 2010, 'Periprocedural stroke and management of major bleeding complications in patients undergoing catheter ablation of atrial fibrillation: The impact of periprocedural therapeutic international normalized ratio', Circulation, vol. 121, no. 23, pp. 2550-2556. https://doi.org/10.1161/CIRCULATIONAHA.109.921320
Di Biase, Luigi ; Burkhardt, J. David ; Mohanty, Prasant ; Sanchez, Javier ; Horton, Rodney ; Gallinghouse, G. Joseph ; Lakkireddy, Dhanunjay ; Verma, Atul ; Khaykin, Yaariv ; Hongo, Richard ; Hao, Steven ; Beheiry, Salwa ; Pelargonio, Gemma ; Dello Russo, Antonio ; Casella, Michela ; Santarelli, Pietro ; Santangeli, Pasquale ; Wang, Paul ; Al-Ahmad, Amin ; Patel, Dimpi ; Themistoclakis, Sakis ; Bonso, Aldo ; Rossillo, Antonio ; Corrado, Andrea ; Raviele, Antonio ; Cummings, Jennifer E. ; Schweikert, Robert A. ; Lewis, William R. ; Natale, Andrea. / Periprocedural stroke and management of major bleeding complications in patients undergoing catheter ablation of atrial fibrillation : The impact of periprocedural therapeutic international normalized ratio. In: Circulation. 2010 ; Vol. 121, No. 23. pp. 2550-2556.
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abstract = "Background-Catheter ablation of atrial fibrillation is associated with the potential risk of periprocedural stroke, which can range between 1{\%} and 5{\%}. We developed a prospective database to evaluate the prevalence of stroke over time and to assess whether the periprocedural anticoagulation strategy and use of open irrigation ablation catheter have resulted in a reduction of this complication. Methods and Results-We collected data from 9 centers performing the same ablation procedure with the same anticoagulation protocol. We divided the patients into 3 groups: ablation with an 8-mm catheter off warfarin (group 1), ablation with an open irrigated catheter off warfarin (group 2), and ablation with an open irrigated catheter on warfarin (group 3). Outcome data on stroke/transient ischemic attack and bleeding complications during and early after the procedures were collected. Of 6454 consecutive patients in the study, 2488 were in group 1, 1348 were in group 2, and 2618 were in group 3. Periprocedural stroke/transient ischemic attack occurred in 27 patients (1.1{\%}) in group 1 and 12 patients (0.9{\%}) in group 2. Despite a higher prevalence of nonparoxysmal atrial fibrillation and more patients with CHADS2 (congestive heart failure, hypertension, age >75 years, diabetes mellitus, and prior stroke or transient ischemic attack) score >2, no stroke/transient ischemic attack was reported in group 3. Complications among groups 1, 2, and 3, including major bleeding (10 [0.4{\%}], 11 [0.8{\%}], and 10 [0.4{\%}], respectively; P>0.05) and pericardial effusion (11 [0.4{\%}], 11 [0.8{\%}], and 12 [0.5{\%}]; P>0.05), were equally distributed. Conclusion-The combination of an open irrigation ablation catheter and periprocedural therapeutic anticoagulation with warfarin may reduce the risk of periprocedural stroke without increasing the risk of pericardial effusion or other bleeding complications.",
keywords = "Atrial fibrillation, Catheter ablation, Embolism, Stroke, Transient ischemic attack, Warfarin",
author = "{Di Biase}, Luigi and Burkhardt, {J. David} and Prasant Mohanty and Javier Sanchez and Rodney Horton and Gallinghouse, {G. Joseph} and Dhanunjay Lakkireddy and Atul Verma and Yaariv Khaykin and Richard Hongo and Steven Hao and Salwa Beheiry and Gemma Pelargonio and {Dello Russo}, Antonio and Michela Casella and Pietro Santarelli and Pasquale Santangeli and Paul Wang and Amin Al-Ahmad and Dimpi Patel and Sakis Themistoclakis and Aldo Bonso and Antonio Rossillo and Andrea Corrado and Antonio Raviele and Cummings, {Jennifer E.} and Schweikert, {Robert A.} and Lewis, {William R.} and Andrea Natale",
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T1 - Periprocedural stroke and management of major bleeding complications in patients undergoing catheter ablation of atrial fibrillation

T2 - The impact of periprocedural therapeutic international normalized ratio

AU - Di Biase, Luigi

AU - Burkhardt, J. David

AU - Mohanty, Prasant

AU - Sanchez, Javier

AU - Horton, Rodney

AU - Gallinghouse, G. Joseph

AU - Lakkireddy, Dhanunjay

AU - Verma, Atul

AU - Khaykin, Yaariv

AU - Hongo, Richard

AU - Hao, Steven

AU - Beheiry, Salwa

AU - Pelargonio, Gemma

AU - Dello Russo, Antonio

AU - Casella, Michela

AU - Santarelli, Pietro

AU - Santangeli, Pasquale

AU - Wang, Paul

AU - Al-Ahmad, Amin

AU - Patel, Dimpi

AU - Themistoclakis, Sakis

AU - Bonso, Aldo

AU - Rossillo, Antonio

AU - Corrado, Andrea

AU - Raviele, Antonio

AU - Cummings, Jennifer E.

AU - Schweikert, Robert A.

AU - Lewis, William R.

AU - Natale, Andrea

PY - 2010/6/15

Y1 - 2010/6/15

N2 - Background-Catheter ablation of atrial fibrillation is associated with the potential risk of periprocedural stroke, which can range between 1% and 5%. We developed a prospective database to evaluate the prevalence of stroke over time and to assess whether the periprocedural anticoagulation strategy and use of open irrigation ablation catheter have resulted in a reduction of this complication. Methods and Results-We collected data from 9 centers performing the same ablation procedure with the same anticoagulation protocol. We divided the patients into 3 groups: ablation with an 8-mm catheter off warfarin (group 1), ablation with an open irrigated catheter off warfarin (group 2), and ablation with an open irrigated catheter on warfarin (group 3). Outcome data on stroke/transient ischemic attack and bleeding complications during and early after the procedures were collected. Of 6454 consecutive patients in the study, 2488 were in group 1, 1348 were in group 2, and 2618 were in group 3. Periprocedural stroke/transient ischemic attack occurred in 27 patients (1.1%) in group 1 and 12 patients (0.9%) in group 2. Despite a higher prevalence of nonparoxysmal atrial fibrillation and more patients with CHADS2 (congestive heart failure, hypertension, age >75 years, diabetes mellitus, and prior stroke or transient ischemic attack) score >2, no stroke/transient ischemic attack was reported in group 3. Complications among groups 1, 2, and 3, including major bleeding (10 [0.4%], 11 [0.8%], and 10 [0.4%], respectively; P>0.05) and pericardial effusion (11 [0.4%], 11 [0.8%], and 12 [0.5%]; P>0.05), were equally distributed. Conclusion-The combination of an open irrigation ablation catheter and periprocedural therapeutic anticoagulation with warfarin may reduce the risk of periprocedural stroke without increasing the risk of pericardial effusion or other bleeding complications.

AB - Background-Catheter ablation of atrial fibrillation is associated with the potential risk of periprocedural stroke, which can range between 1% and 5%. We developed a prospective database to evaluate the prevalence of stroke over time and to assess whether the periprocedural anticoagulation strategy and use of open irrigation ablation catheter have resulted in a reduction of this complication. Methods and Results-We collected data from 9 centers performing the same ablation procedure with the same anticoagulation protocol. We divided the patients into 3 groups: ablation with an 8-mm catheter off warfarin (group 1), ablation with an open irrigated catheter off warfarin (group 2), and ablation with an open irrigated catheter on warfarin (group 3). Outcome data on stroke/transient ischemic attack and bleeding complications during and early after the procedures were collected. Of 6454 consecutive patients in the study, 2488 were in group 1, 1348 were in group 2, and 2618 were in group 3. Periprocedural stroke/transient ischemic attack occurred in 27 patients (1.1%) in group 1 and 12 patients (0.9%) in group 2. Despite a higher prevalence of nonparoxysmal atrial fibrillation and more patients with CHADS2 (congestive heart failure, hypertension, age >75 years, diabetes mellitus, and prior stroke or transient ischemic attack) score >2, no stroke/transient ischemic attack was reported in group 3. Complications among groups 1, 2, and 3, including major bleeding (10 [0.4%], 11 [0.8%], and 10 [0.4%], respectively; P>0.05) and pericardial effusion (11 [0.4%], 11 [0.8%], and 12 [0.5%]; P>0.05), were equally distributed. Conclusion-The combination of an open irrigation ablation catheter and periprocedural therapeutic anticoagulation with warfarin may reduce the risk of periprocedural stroke without increasing the risk of pericardial effusion or other bleeding complications.

KW - Atrial fibrillation

KW - Catheter ablation

KW - Embolism

KW - Stroke

KW - Transient ischemic attack

KW - Warfarin

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