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Multicenter Study
. 2014 May;11(5):791-8.
doi: 10.1016/j.hrthm.2014.03.003. Epub 2014 Mar 4.

Does periprocedural anticoagulation management of atrial fibrillation affect the prevalence of silent thromboembolic lesion detected by diffusion cerebral magnetic resonance imaging in patients undergoing radiofrequency atrial fibrillation ablation with open irrigated catheters? Results from a prospective multicenter study

Luigi Di Biase  1 , Fiorenzo Gaita  2 , Elisabetta Toso  2 , Pasquale Santangeli  3 , Prasant Mohanty  4 , Neal Rutledge  5 , Xue Yan  4 , Sanghamitra Mohanty  4 , Chintan Trivedi  4 , Rong Bai  4 , Justin Price  4 , Rodney Horton  4 , G Joseph Gallinghouse  4 , Salwa Beheiry  4 , Jason Zagrodzky  4 , Robert Canby  4 , Jean François Leclercq  6 , Franck Halimi  7 , Marco Scaglione  8 , Federico Cesarani  9 , Riccardo Faletti  10 , Javier Sanchez  4 , J David Burkhardt  4 , Andrea Natale  11
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Free article
Multicenter Study

Does periprocedural anticoagulation management of atrial fibrillation affect the prevalence of silent thromboembolic lesion detected by diffusion cerebral magnetic resonance imaging in patients undergoing radiofrequency atrial fibrillation ablation with open irrigated catheters? Results from a prospective multicenter study

Luigi Di Biase et al. Heart Rhythm. 2014 May.
Free article

Abstract

Background: Silent cerebral ischemia (SCI) has been reported in 14% of cases after catheter ablation of atrial fibrillation (AF) with radiofrequency (RF) energy and discontinuation of warfarin before AF ablation procedures.

Objective: The purpose of this study was to determine whether periprocedural anticoagulation management affects the incidence of SCI after RF ablation using an open irrigated catheter.

Methods: Consecutive patients undergoing RF ablation for AF without warfarin discontinuation and receiving heparin bolus before transseptal catheterization (group I, n = 146) were compared with a group of patients who had protocol deviation in terms of maintaining the therapeutic preprocedural international normalized ratio (patients with subtherapeutic INR) and/or failure to receive pretransseptal heparin bolus infusion and/or ≥2 consecutive ACT measurements <300 seconds (noncompliant population, group II, n = 134) and with a group of patients undergoing RF ablation with warfarin discontinuation bridged with low molecular weight heparin (group III, n = 148). All patients underwent preablation and postablation (within 48 hours) diffusion magnetic resonance imaging.

Results: SCI was detected in 2% of patients (3/146) in group I, 7% (10/134) in group II, and 14% (21/148) in group III (P <.001). "Therapeutic INR" was strongly associated with a lower prevalence of postprocedural silent cerebral ischemia (SCI). Multivariable analysis demonstrated nonparoxysmal AF (odds ratio 3.8, 95% confidence interval 1.5-9.7, P = .005) and noncompliance to protocol (odds ratio 2.8, 95% confidence interval 1.5-5.1, P <.001] to be significant predictors of ischemic events.

Conclusion: Strict adherence to an anticoagulation protocol significantly reduces the prevalence of SCI after catheter ablation of AF with RF energy.

Keywords: Ablation; Atrial fibrillation; Periprocedural; Radiofrequency; Silent cerebral ischemia; Stroke; Warfarin.

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