title: Effect of catheter ablation and periprocedural anticoagulation regimen on the clinical course of migraine in atrial fibrillation patients with or without pre-existent migraine: results from a prospective study.
abstract: BACKGROUND
  We examined the influence of catheter ablation and periprocedural anticoagulation regimen on trajectory of migraine in atrial fibrillation patients with or without migraine history.
  
  
  RESULTS
  Forty patients with (group 1: 64 ± 8 years; men 78%) and 85 (group 2: 61 ± 10 years; men 73%) without migraine history undergoing atrial fibrillation-ablation were enrolled. Migraine status and quality of life were evaluated using standardized questionnaires. Diffusion magnetic resonance imaging of brain was performed for all at pre and 24 hours post procedure. Catheter ablation was performed with (88, 70%) or without (37, 30%) continuous warfarin treatment. Fifty-four patients (11 and 43 from groups 1 and 2, respectively) had subtherapeutic international normalized ratio on procedure day. At 17 ± 5 months follow-up, from group 1, 25 (63%) reported no migraine, 10 (25%) had < 1, and 3 (8%) had 2 to 3 monthly symptoms. Intensity of pain decreased from baseline 7 (Q1-Q3, 4-8) to 2 (0-4) scale points at follow-up (P < 0.001) and duration of headache from median 8 (Q1-Q3, 4-15) to 0.5 (Q1-Q3, 0-2) hours (P < 0.001). Two patients from group 1 reported increased migraine severity and 2 from group 2 had new-onset migraine. Follow-up diffusion magnetic resonance imaging revealed new infarcts in 9.6% (12/125) patients; of which 11 had subtherapeutic preprocedural international normalized ratio on or off continuous warfarin. Quality of life improved significantly in patients with successful ablation, being more pronounced in group 1.
  
  
  CONCLUSIONS
  In most patients, migraine symptoms improved substantially after catheter ablation. Interestingly, the only cases of new migraine and aggravation of pre-existent headache had subtherapeutic international normalized ratio during the procedure and new cerebral infarcts.
authors: From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.).
authors: Sanghamitra
authors: S
authors: Mohanty
authors: From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.).
authors: Prasant
authors: P
authors: Mohanty
authors: From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.).
authors: J Neal
authors: JN
authors: Rutledge
authors: From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.).
authors: Luigi
authors: L
authors: Di Biase
authors: From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.).
authors: Rachel Xue
authors: RX
authors: Yan
authors: From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.).
authors: Chintan
authors: C
authors: Trivedi
authors: From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.).
authors: Pasquale
authors: P
authors: Santangeli
authors: From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.).
authors: Rong
authors: R
authors: Bai
authors: From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.).
authors: Deb
authors: D
authors: Cardinal
authors: From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.).
authors: J David
authors: JD
authors: Burkhardt
authors: From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.).
authors: Joseph G
authors: JG
authors: Gallinghouse
authors: From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.).
authors: Rodney
authors: R
authors: Horton
authors: From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.).
authors: Javier E
authors: JE
authors: Sanchez
authors: From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.).
authors: Shane
authors: S
authors: Bailey
authors: From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.).
authors: Patrick M
authors: PM
authors: Hranitzky
authors: From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.).
authors: Jason
authors: J
authors: Zagrodzky
authors: From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.).
authors: Amin
authors: A
authors: Al-Ahmad
authors: From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.). dr.natale@gmail.com.
authors: Andrea
authors: A
authors: Natale
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects; D038524:Diffusion Magnetic Resonance Imaging; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications* / Q000175:diagnosis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: atrial fibrillation; catheter ablation; diffusion MRI; migraine disorders