Luigi Di Biase1, Fiorenzo Gaita2, Elisabetta Toso2, Pasquale Santangeli3, Prasant Mohanty4, Neal Rutledge5, Xue Yan4, Sanghamitra Mohanty4, Chintan Trivedi4, Rong Bai4, Justin Price4, Rodney Horton4, G Joseph Gallinghouse4, Salwa Beheiry4, Jason Zagrodzky4, Robert Canby4, Jean François Leclercq6, Franck Halimi7, Marco Scaglione8, Federico Cesarani9, Riccardo Faletti10, Javier Sanchez4, J David Burkhardt4, Andrea Natale11. 1. Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Albert Einstein College of Medicine at Montefiore Hospital, New York, New York; Department of Biomedical Engineering, University of Texas, Austin, Texas; Department of Cardiology, University of Foggia, Foggia, Italy. 2. Department of Medical Sciences, University of Turin, Turin, Italy. 3. Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Department of Cardiology, University of Foggia, Foggia, Italy. 4. Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas. 5. Austin Radiological Association, Austin, Texas. 6. California Pacific Medical Center, San Francisco, California. 7. Department of Rythmology, CMC Parly II Le Chesnay, Le Chesnay, France. 8. Division of Cardiology, Cardinal Guglielmo Massaia Hospital, Asti, Italy. 9. Division of Radiology, Cardinal Guglielmo Massaia Hospital, Asti, Italy. 10. Radiology Institute, Department of Surgical Sciences, University of Turin, Turin, Italy. 11. Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Department of Biomedical Engineering, University of Texas, Austin, Texas; California Pacific Medical Center, San Francisco, California; Division of Cardiology, Stanford University, Palo Alto, California; Heart and Vascular Center, Case Western Reserve University, Cleveland, Ohio. Electronic address: dr.natale@gmail.com.
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.
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.
Authors: Patrick Müller; Johannes Maier; Johannes-Wolfgang Dietrich; Sebastian Barth; Daniel P Griese; Fabian Schiedat; Attila Szöllösi; Philipp Halbfass; Karin Nentwich; Markus Roos; Joachim Krug; Anja Schade; Rainer Schmitt; Andreas Mügge; Thomas Deneke Journal: J Interv Card Electrophysiol Date: 2015-06-06 Impact factor: 1.900
Authors: Aref A Bin Abdulhak; Kevin F Kennedy; Sanjaya Gupta; Michael Giocondo; Brian Ramza; Alan P Wimmer Journal: J Interv Card Electrophysiol Date: 2015-08-21 Impact factor: 1.900