title: Silent Cerebral Ischemic Lesions After Catheter Ablation of Atrial Fibrillation in Patients on 5 Types of Periprocedural Oral Anticoagulation　- Predictors of Diffusion-Weighted Imaging-Positive Lesions and Follow-up Magnetic Resonance Imaging.
abstract: BACKGROUND
  The aim of this study was to identify the predictors of silent cerebral ischemic lesions (SCIL) after catheter ablation of atrial fibrillation (AF) and to determine whether SCIL develop into cerebral infarcts in patients with 5 types of oral anticoagulants (OAC).
  
  
  RESULTS
  We retrospectively studied 286 consecutive patients (median, 67 years; 208 male; paroxysmal/persistent/long-standing persistent AF [LSP-AF], 147/90/49) who received periprocedural OAC and underwent MRI after the procedure. Warfarin (n=46) was continued, while dabigatran (n=47), rivaroxaban (n=89), apixaban (n=87), and edoxaban (n=17) were discontinued on the day of the procedure. I.v. heparin was infused to maintain an activated clotting time of 300-350 s during the procedure. Fifty-eight SCIL in 40 patients (14.0%) were identified on diffusion-weighted MRI. On multivariate logistic analysis, LSP-AF and dabigatran use were significant positive predictors of SCIL (OR, 2.912 and 2.287; P=0.006 and 0.042, respectively). Among 34 patients with 49 SCIL undergoing follow-up MRI, 45 (91.8%) of the lesions disappeared and 4 lesions developed into chronic cerebral infarcts. The SCIL with development into infarcts had a larger lesion diameter than those without (median, 6.55 mm vs. 4.2 mm; P=0.002).
  
  
  CONCLUSIONS
  LSP-AF and dabigatran use were independent risk factors for post-ablation SCIL in patients with uninterrupted warfarin and interrupted non-vitamin K antagonist OAC, but the majority of SCIL disappeared.
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center.
authors.forename: Kohki
authors.initials: K
authors.lastname: Nakamura
authors.forename: Shigeto
authors.initials: S
authors.lastname: Naito
authors.forename: Takehito
authors.initials: T
authors.lastname: Sasaki
authors.forename: Kentaro
authors.initials: K
authors.lastname: Minami
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Take
authors.forename: Eri
authors.initials: E
authors.lastname: Goto
authors.forename: Satoru
authors.initials: S
authors.lastname: Shimizu
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Yamaguchi
authors.forename: Naoko
authors.initials: N
authors.lastname: Suzuki
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Yano
authors.forename: Michiharu
authors.initials: M
authors.lastname: Senga
authors.forename: Koji
authors.initials: K
authors.lastname: Kumagai
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kaseno
authors.forename: Nobusada
authors.initials: N
authors.lastname: Funabashi
authors.forename: Shigeru
authors.initials: S
authors.lastname: Oshima
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000628:therapy*; D020520:Brain Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D017115:Catheter Ablation / Q000009:adverse effects*; D000069604:Dabigatran / Q000008:administration & dosage / Q000009:adverse effects; D038524:Diffusion Magnetic Resonance Imaging; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants; D000069604:Dabigatran