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

231 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Di Biase, L., Burkhardt, J. D., Mohanty, P., Sanchez, J., Horton, R., Gallinghouse, G. J., 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., ... 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, 121(23), 2550-2556. https://doi.org/10.1161/CIRCULATIONAHA.109.921320