TY - JOUR
T1 - Thromboembolic Risk in Atrial Fibrillation Patients With Left Atrial Scar Post-Extensive Ablation
T2 - A Single-Center Experience
AU - Mohanty, Sanghamitra
AU - Trivedi, Chintan
AU - Della Rocca, Domenico G.
AU - Baqai, Faiz M.
AU - Anannab, Alisara
AU - Gianni, Carola
AU - MacDonald, Bryan
AU - Quintero Mayedo, Angel
AU - Bassiouny, Mohamed
AU - Gallinghouse, G. Joseph
AU - Burkhardt, John D.
AU - Horton, Rodney
AU - Al-Ahmad, Amin
AU - Di Biase, Luigi
AU - Natale, Andrea
N1 - Publisher Copyright:
© 2021 American College of Cardiology Foundation
PY - 2021/3
Y1 - 2021/3
N2 - Objectives: This study evaluated the association of the post-ablation scar with stroke risk in patients undergoing atrial fibrillation (AF) ablation. Background: Late gadolinium enhancement–cardiac magnetic resonance studies have reported a direct association between pre-ablation left atrial scar and thromboembolic events in patients with AF. Methods: Consecutive patients with AF were classified into 2 groups based on the type of ablation performed at the first procedure. Group 1 involved limited ablation (isolation of pulmonary veins, left atrial posterior wall, and superior vena cava); and group 2 involved extensive ablation (limited ablation + ablation of nonpulmonary vein triggers from all sites except left atrial appendage). During the repeat procedure, post-ablation scar (region with bipolar voltage amplitude <0.5 mV) was identified by using 3-dimensional voltage mapping. Results: A total of 6,297 patients were included: group 1, n = 1,713; group 2, n = 4,584. Group 2 patients were significantly older and had more nonparoxysmal AF. Nineteen (0.3%) thromboembolic events were reported after the first ablation procedure: 9 (1.02%) in group 1 and 10 (0.61%) in group 2 (p = 0.26). At the time of the event, all 19 patients were experiencing arrhythmia. Median time to stroke was 14 (interquartile range: 9 to 20) months in group 1 and 14.5 (interquartile range: 8 to 18) months in group 2. Post-ablation scar data were derived from 2,414 patients undergoing repeat ablation. Mean scar area was detected as 67.1 ± 4.6% in group 2 and 34.9 ± 8.8% in group 1 at the redo procedure (p < 0.001). Conclusions: Differently from the cardiac magnetic resonance–detected pre-ablation scar, scar resulting from extensive ablation was not associated with increased risk of stroke compared with that from the limited ablation.
AB - Objectives: This study evaluated the association of the post-ablation scar with stroke risk in patients undergoing atrial fibrillation (AF) ablation. Background: Late gadolinium enhancement–cardiac magnetic resonance studies have reported a direct association between pre-ablation left atrial scar and thromboembolic events in patients with AF. Methods: Consecutive patients with AF were classified into 2 groups based on the type of ablation performed at the first procedure. Group 1 involved limited ablation (isolation of pulmonary veins, left atrial posterior wall, and superior vena cava); and group 2 involved extensive ablation (limited ablation + ablation of nonpulmonary vein triggers from all sites except left atrial appendage). During the repeat procedure, post-ablation scar (region with bipolar voltage amplitude <0.5 mV) was identified by using 3-dimensional voltage mapping. Results: A total of 6,297 patients were included: group 1, n = 1,713; group 2, n = 4,584. Group 2 patients were significantly older and had more nonparoxysmal AF. Nineteen (0.3%) thromboembolic events were reported after the first ablation procedure: 9 (1.02%) in group 1 and 10 (0.61%) in group 2 (p = 0.26). At the time of the event, all 19 patients were experiencing arrhythmia. Median time to stroke was 14 (interquartile range: 9 to 20) months in group 1 and 14.5 (interquartile range: 8 to 18) months in group 2. Post-ablation scar data were derived from 2,414 patients undergoing repeat ablation. Mean scar area was detected as 67.1 ± 4.6% in group 2 and 34.9 ± 8.8% in group 1 at the redo procedure (p < 0.001). Conclusions: Differently from the cardiac magnetic resonance–detected pre-ablation scar, scar resulting from extensive ablation was not associated with increased risk of stroke compared with that from the limited ablation.
KW - atrial fibrillation
KW - catheter ablation
KW - left atrial scar
KW - stroke
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U2 - 10.1016/j.jacep.2020.08.035
DO - 10.1016/j.jacep.2020.08.035
M3 - Article
C2 - 33736751
AN - SCOPUS:85097456004
SN - 2405-500X
VL - 7
SP - 308
EP - 318
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 3
ER -