title: Impact of periprocedural anticoagulation strategy on the incidence of new-onset silent cerebral events after radiofrequency catheter ablation of atrial fibrillation.
abstract: BACKGROUND
  Silent cerebral events (SCEs) have been observed on diffusion-weighted cerebral magnetic resonance imaging (MRI) in a substantial number of asymptomatic patients after atrial fibrillation (AF) ablation procedures. The purpose of this study was to investigate if periprocedural oral anticoagulation (OAC) management affects the incidence of new-onset SCE after radiofrequency catheter ablation (RFCA) of AF.
  
  
  RESULTS
  One hundred ninety-two consecutive patients (64 ± 10.1 years, 38.5 % women) with symptomatic paroxysmal (n = 80, 41.7 %) or persistent AF undergoing RFCA of AF were prospectively enrolled. Periprocedural anticoagulation strategies were defined as uninterrupted use of novel oral anticoagulants (NOACs) (group I, n = 64), interrupted use of NOACs (group II, n = 42), continuation of vitamin K antagonist (VKA) with an international normalized ratio (INR) between 2.0 and 3.0 (group III, n = 43), and VKA discontinuation bridged with low molecular weight heparin (group IV, n = 43). Cerebral MRI was performed 1 to 2 days after RFCA for detection of new SCE. Overall, new SCEs were detected in 41 patients (21.4 %) after AF ablation. New SCEs were detected in 12.5 % in group I, 35.7 % in group II, 18.6 % in group III, and 23.3 % in group IV (p < 0.05). Multivariable logistic regression analysis revealed persistent AF and discontinuation of periprocedural OAC (group II and IV) to be independent predictors for the development of SCE. No relevant complications were identified.
  
  
  CONCLUSIONS
  Periprocedural continuation of NOAC as well as continuation of VKA seems to be safe and significantly reduce the occurrence of SCE after AF ablation.
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Bavaria, Germany. mueller.patr@googlemail.com.|University Hospital Düsseldorf, Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany. mueller.patr@googlemail.com.
authors.forename: Patrick
authors.initials: P
authors.lastname: Müller
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Bavaria, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Halbfass
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Bavaria, Germany.
authors.forename: Attila
authors.initials: A
authors.lastname: Szöllösi
authors.affiliation: University Hospital Bergmannsheil, Clinic for Cardiology and Angiology, Ruhr-University Bochum, Bochum, NRW, Germany.
authors.forename: Johannes-Wolfgang
authors.initials: JW
authors.lastname: Dietrich
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Bavaria, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Fochler
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Bavaria, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Nentwich
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Bavaria, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Roos
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Bavaria, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Krug
authors.affiliation: Heart Center Bad Neustadt, Clinic for Radiology, Bad Neustadt an der Saale, Bavaria, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Schmitt
authors.affiliation: University Hospital Bergmannsheil, Clinic for Cardiology and Angiology, Ruhr-University Bochum, Bochum, NRW, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Mügge
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Bavaria, Germany.|University Hospital Bergmannsheil, Clinic for Cardiology and Angiology, Ruhr-University Bochum, Bochum, NRW, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Deneke
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D058070:Asymptomatic Diseases; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data; D015984:Causality; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011292:Premedication; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation management; Atrial fibrillation; Catheter ablation; Magnetic resonance imaging; Silent cerebral events