Periprocedural stroke and management of major bleeding complications in patients undergoing catheter ablation of atrial fibrillation: the impact of periprocedural therapeutic international normalized ratio.
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.


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.


CONCLUSIONS
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.
Executive Texas Cardiac Arrhythmia Institute, St David's Medical Center, 1015 E 32th St, Suite 516, Austin, TX 78705, USA.
Luigi
L
Di Biase
J David
JD
Burkhardt
Prasant
P
Mohanty
Javier
J
Sanchez
Rodney
R
Horton
G Joseph
GJ
Gallinghouse
Dhanunjay
D
Lakkireddy
Atul
A
Verma
Yaariv
Y
Khaykin
Richard
R
Hongo
Steven
S
Hao
Salwa
S
Beheiry
Gemma
G
Pelargonio
Antonio
A
Dello Russo
Michela
M
Casella
Pietro
P
Santarelli
Pasquale
P
Santangeli
Paul
P
Wang
Amin
A
Al-Ahmad
Dimpi
D
Patel
Sakis
S
Themistoclakis
Aldo
A
Bonso
Antonio
A
Rossillo
Andrea
A
Corrado
Antonio
A
Raviele
Jennifer E
JE
Cummings
Robert A
RA
Schweikert
William R
WR
Lewis
Andrea
A
Natale
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000097:blood* / Q000628:therapy; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D017115:Catheter Ablation / Q000009:adverse effects*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D019934:International Normalized Ratio; D007431:Intraoperative Complications / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000009:adverse effects; D011446:Prospective Studies; D020521:Stroke / Q000097:blood* / Q000209:etiology / Q000517:prevention & control
D000925:Anticoagulants