title: Late-phase thromboembolism after catheter ablation for paroxysmal atrial fibrillation.
abstract: BACKGROUND
  The aim of this study was to investigate the incidence and predictors (which have not previously been fully elucidated) of late-phase thromboembolism (TE) after catheter ablation (CA) for paroxysmal atrial fibrillation (AF).
  
  
  RESULTS
  We studied 1,156 consecutive patients (61±10 years; 891 men; CHADS2score, 0.8±1.0) after CA for symptomatic paroxysmal AF and examined the details of late-phase TE. During a follow-up of 49.5±21.9 months (median, 47 months; range, 6-113 months) after CA, 9 patients (0.78%) developed late-phase TE, all of which were ischemic stroke. Of these, 5 patients with AF recurrence experienced cardioembolism; the AF was asymptomatic at recurrence. The remaining 4 without AF recurrence experienced cardioembolism (n=1), small-vessel occlusion (n=1), large-artery atherosclerosis (n=1), and stroke of other determined etiology (n=1). On Kaplan-Meier analysis patients with structural heart disease (P=0.003), AF recurrence after the final CA (P=0.01), prior stroke (P=0.002), CHADS2score ≥2 (P=0.0002), left ventricular ejection fraction <50% (P<0.0001), and spontaneous echo contrast on transesophageal echocardiogram (P=0.0004) had a significantly higher risk of late-phase TE. Multivariate analysis indicated that CHADS2score ≥2 (HR, 4.49; 95% CI: 1.08-22.56; P=0.04) independently predicted late-phase TE.
  
  
  CONCLUSIONS
  The incidence of TE was low after CA for paroxysmal AF, but CHADS2score ≥2 independently increased the risk of late-phase TE.
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital.
authors.forename: Masateru
authors.initials: M
authors.lastname: Takigawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
authors.forename: Taishi
authors.initials: T
authors.lastname: Kuwahara
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Kenji
authors.initials: K
authors.lastname: Okubo
authors.forename: Emiko
authors.initials: E
authors.lastname: Nakashima
authors.forename: Yuji
authors.initials: Y
authors.lastname: Watari
authors.forename: Jun
authors.initials: J
authors.lastname: Nakajima
authors.forename: Katsumasa
authors.initials: K
authors.lastname: Takagi
authors.forename: Kazuya
authors.initials: K
authors.lastname: Yamao
authors.forename: Tadashi
authors.initials: T
authors.lastname: Fujino
authors.forename: Tomoyo
authors.initials: T
authors.lastname: Sugiyama
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kimura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hikita
authors.forename: Takashi
authors.initials: T
authors.lastname: Irioka
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirao
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects*; D018572:Disease-Free Survival; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D012307:Risk Factors; D013318:Stroke Volume; D015996:Survival Rate; D013923:Thromboembolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D013997:Time Factors