Periprocedural Stroke and Management of Major Bleeding Complications in Patients Undergoing Catheter Ablation of Atrial Fibrillation
Male
Cardiac Catheterization
Blood Loss, Surgical
Anticoagulants
Disease Management
Hemorrhage
Middle Aged
Perioperative Care
3. Good health
Stroke
03 medical and health sciences
0302 clinical medicine
Atrial Fibrillation
Catheter Ablation
Humans
Female
International Normalized Ratio
Prospective Studies
Intraoperative Complications
Aged
Follow-Up Studies
DOI:
10.1161/circulationaha.109.921320
Publication Date:
2010-06-02T01:41:40Z
AUTHORS (29)
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.
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