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Catheter ablation safe in patients with AF, prior cerebrovascular event
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Patients with atrial fibrillation and a prior cerebrovascular event were not at increased risk for a new cerebrovascular event or other thromboembolic event after catheter ablation with uninterrupted anticoagulation, according to recent study findings.
Researchers analyzed 247 patients with AF and a prior cerebrovascular event (median age, 64 years; 40.1% women; median CHA2DS2-VASc score, 4) who underwent catheter ablation between 2000 and August 2014 at Cleveland Clinic.
“We hypothesized that patients with a prior history of cerebrovascular events are not predisposed to significant risk of clinical recurrence when undergoing catheter ablation without interruption of therapeutic anticoagulation, and should not be denied catheter ablation as a treatment option based on their clinical history,” Ayman A. Hussein, MD, from the Center for Atrial Fibrillation, Cleveland Clinic, and colleagues wrote.
The outcomes of interest were thromboembolic and hemorrhagic complications during the procedure and at least 3 months after the procedure.
Of the patients, 67.6% had a prior stroke, 25.5% had a prior transient ischemic attack and 6.9% had a documented history of a prior cerebrovascular event for which more information was not available. Median time from cerebrovascular event to ablation was 24 months (interquartile range, 10-49).
Most patients were assigned warfarin (77.7%), with 13% assigned dabigatran (Pradaxa, Boehringer Ingelheim), 6.1% assigned rivaroxaban (Xarelto, Janssen Pharmaceuticals) and 3.2% assigned apixaban (Eliquis, Bristol-Myers Squibb/Pfizer). One patient was discontinued on warfarin and was given heparin for periprocedural bridging, but all others remained on their oral anticoagulation during the procedure, according to the researchers.
During the procedure, all patients had all four pulmonary veins successfully isolated with catheter ablation (98% radiofrequency ablation, 2% cryoablation), they wrote.
No patients had periprocedural or postprocedural thromboembolic events, Hussein and colleagues wrote.
They reported the following acute procedural complications: five groin hematomas (one requiring transfusion), five pericardial effusions (two requiring intervention) and one arteriovenous fistula.
“The results are remarkable for showing a zero incidence of new thromboembolic episodes postprocedurally,” Hussein and colleagues wrote. “This indicates that AF ablation undertaken in patients with prior history of cerebrovascular events is not associated with a significant risk of clinical recurrence of such events and may be offered safely in selected cases with the strict anticoagulation protocols used.” – by Erik Swain
Disclosure: The researchers report no relevant financial disclosures.
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