TY - JOUR
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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UR - http://www.scopus.com/inward/citedby.url?scp=77953809216&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.109.921320
DO - 10.1161/CIRCULATIONAHA.109.921320
M3 - Article
C2 - 20516376
AN - SCOPUS:77953809216
SN - 0009-7322
VL - 121
SP - 2550
EP - 2556
JO - Circulation
JF - Circulation
IS - 23
ER -
