Periprocedural Stroke and Management of Major Bleeding Complications in Patients Undergoing Catheter Ablation of Atrial Fibrillation
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Published:2010-06-15
Issue:23
Volume:121
Page:2550-2556
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ISSN:0009-7322
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Container-title:Circulation
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language:en
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Short-container-title:Circulation
Author:
Di Biase Luigi1, Burkhardt J. David1, Mohanty Prasant1, Sanchez Javier1, Horton Rodney1, Gallinghouse G. Joseph1, Lakkireddy Dhanunjay1, Verma Atul1, Khaykin Yaariv1, Hongo Richard1, Hao Steven1, Beheiry Salwa1, Pelargonio Gemma1, Dello Russo Antonio1, Casella Michela1, Santarelli Pietro1, Santangeli Pasquale1, Wang Paul1, Al-Ahmad Amin1, Patel Dimpi1, Themistoclakis Sakis1, Bonso Aldo1, Rossillo Antonio1, Corrado Andrea1, Raviele Antonio1, Cummings Jennifer E.1, Schweikert Robert A.1, Lewis William R.1, Natale Andrea1
Affiliation:
1. From the Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (L.D.B., J.D.B., P.M., J.S., R.H., G.J.G., D.P., A.N.); Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., R.H., A.N.); University of Kansas, Kansas City (D.L.); Southlake Regional Health Center, New Market, Ontario, Canada (A.V., Y.K.); California Pacific Medical Center, San Francisco (R.H., S.H., S.B., A.N.); Catholic...
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.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Physiology (medical),Cardiology and Cardiovascular Medicine
Cited by
264 articles.
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