title: Delaying cardioversion following 4-week anticoagulation in case of persistent atrial fibrillation after a transcatheter ablation procedure to reduce silent cerebral thromboembolism:  a single-center pilot study.
abstract: BACKGROUND
  Symptomatic cerebral thromboembolism occurs in 0.4% of transcatheter atrial fibrillation ablation procedures. Silent cerebral events, instead, have recently been reported in up to 14%, especially clustered within patients undergoing cardioversion at the end of the procedure. The present study reports the incidence of silent cerebral thromboembolism, assessed by cerebral MRI, delaying electrical cardioversion, in case of lack of sinus rhythm restoration at the end of the procedure, after 4 weeks of effective anticoagulation.
  
  
  RESULTS
  Ninety-five consecutive patients with antiarrhythmic drug refractory atrial fibrillation were referred for transcatheter ablation and enrolled in the study. All patients underwent pre-ablation and post-ablation cerebral MRI. Overall, post-ablation cerebral MRI registered new thromboembolism in six (6%) patients. Fifty-five (58%) patients remained in sinus rhythm throughout the procedure and 40 (42%) reported persistent atrial fibrillation, yielding a silent thromboembolism incidence of 5 and 8%, respectively. In particular, silent thromboembolism was registered in one (4%) of the 25 patients achieving sinus rhythm by catheters, in two (18%) of the 11 patients spontaneously restoring sinus rhythm shortly following the procedure and in none of the four patients cardioverted following 4-week anticoagulation. In a matched reference population, a significantly higher percentage of patients (15, 16% vs. 6, 6%; P = 0.03) suffered from a new post-ablation thromboembolism; particularly within patients terminating the procedure in atrial fibrillation. Delaying cardioversion reduced silent cerebral thromboembolism from 38 to 13%.
  
  
  CONCLUSIONS
  Delaying electrical cardioversion after a 4-week anticoagulation period reduced the risk of silent cerebral thromboembolism and is a viable and safer option in patients terminating a transcatheter ablation procedure in atrial fibrillation.
authors.affiliation: Cardiology Division, Department of Internal Medicine, San Giovanni Battista Hospital University of Turin, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Pianelli
authors.forename: Marco
authors.initials: M
authors.lastname: Scaglione
authors.forename: Matteo
authors.initials: M
authors.lastname: Anselmino
authors.forename: Domenico
authors.initials: D
authors.lastname: Caponi
authors.forename: Paloma
authors.initials: P
authors.lastname: Garcia
authors.forename: Federico
authors.initials: F
authors.lastname: Cesarani
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Toso
authors.forename: Cristina
authors.initials: C
authors.lastname: Raimondo
authors.forename: Franck
authors.initials: F
authors.lastname: Halimi
authors.forename: Jean François
authors.initials: JF
authors.lastname: Leclercq
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects*; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D004554:Electric Countershock; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007558:Italy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013923:Thromboembolism / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants