Safety and efficacy of contemporary catheter ablation for atrial fibrillation patients with a history of cardioembolic stroke in the era of direct oral anticoagulants.
The safety and efficacy of the contemporary atrial fibrillation (AF) ablation in patients with a recent or previous history of cardioembolic stroke (CS) or transient ischemic attack (TIA) remain to be established.



A total of 447 patients who underwent first-ever contact force (CF)-guided AF ablation with circumferential pulmonary vein isolation were included. Of these, 17 had CS or TIA within 6 months before ablation (Group 1), 30 more than 6 months before ablation (Group 2), and the other 400 without CS or TIA (Group 3). Procedural complications and recurrence of AF and atrial tachyarrhythmias were compared among the 3 groups.



The mean age was 71±7, 66±9, and 61±11 years in Groups 1, 2, and 3, respectively (p<0.05, Group 1 versus Group 3). The oral anticoagulants were warfarin (n=108, 24.1%), dabigatran (n=101, 22.6%), rivaroxaban (n=147, 32.9%), apixaban (n=87, 19.5%), and edoxaban (n=4, 0.9%), and did not differ among the 3 groups. Median follow-up period was 14 [IQR 12-22], 13 [12-14], and 12 [10-16] months, respectively. One episode of cardiac tamponade, 2 episodes of arteriovenous fistula, and some minor complications occurred in Group 3, but no complications occurred in Groups 1 and 2 in the periprocedural period. Although one episode of CS occurred 11 days after the procedure in Group 3, there were no periprocedural CS, TIA, or major bleedings in Groups 1 and 2. AF recurrence-free rate after the procedure was 76.5%, 86.7%, and 79.1% in Groups 1, 2, and 3, respectively, and there was no difference in Kaplan-Meier curves among the 3 groups.



The safety and efficacy of CF-guided AF ablation in the era of direct oral anticoagulants in patients with a recent or previous history of CS or TIA are similar to those in patients without it.
Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Kimitaka
K
Nishizaki
Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Taihei
T
Itoh
Department of Hypertension and Stroke Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Masaomi
M
Kimura
Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Yuichi
Y
Tsushima
Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Yoshihiro
Y
Shoji
Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Takahiko
T
Kinjo
Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Yuji
Y
Ishida
Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Kenichi
K
Sasaki
Department of Advanced Management of Cardiac Arrhythmia, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Daisuke
D
Horiuchi
Department of Advanced Management of Cardiac Arrhythmia, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Shingo
S
Sasaki
Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Hypertension and Stroke Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Hirofumi
H
Tomita
Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan. Electronic address: okumura@hirosaki-u.ac.jp.
Ken
K
Okumura
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D000069604:Dabigatran / Q000627:therapeutic use; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D002546:Ischemic Attack, Transient; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery; D011720:Pyrazoles / Q000627:therapeutic use; D011725:Pyridines / Q000627:therapeutic use; D011728:Pyridones / Q000627:therapeutic use; D000069552:Rivaroxaban / Q000627:therapeutic use; D020521:Stroke; D013844:Thiazoles / Q000627:therapeutic use; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D011720:Pyrazoles; D011725:Pyridines; D011728:Pyridones; D013844:Thiazoles; C522181:apixaban; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran; C552171:edoxaban
Atrial fibrillation; Cardioembolic stroke; Catheter ablation; Contact force; Direct oral anticoagulants