TY - JOUR
T1 - Incidence and predictors of periprocedural cerebrovascular accident in patients undergoing catheter ablation of atrial fibrillation
AU - Scherr, Daniel
AU - Sharma, Kavita
AU - Dalal, Darshan
AU - Spragg, David
AU - Chilukuri, Karuna
AU - Cheng, Alan
AU - Dong, Jun
AU - Henrikson, Charles A.
AU - Nazarian, Saman
AU - Berger, Ronald D.
AU - Calkins, Hugh
AU - Marine, Joseph E.
PY - 2009/12
Y1 - 2009/12
N2 - Periprocedural CVA in AF Ablation. Background: Cerebrovascular accident (CVA) is a serious complication of catheter ablation of atrial fibrillation (AF). The incidence and clinical predictors of periprocedural CVA in patients undergoing AF ablation are not fully understood. Methods: This study included 721 cases (age 57 ± 11 years; 23% female; 345 persistent AF) in 579 consecutive patients referred for AF ablation. Periprocedural CVA was defined as onset of a new neurologic deficit that occurred anytime between the start of the procedure and 30 days after the AF ablation, and was confirmed by a neurologist. Cranial imaging with CT and/or MRI was performed in each case. Patients were anticoagulated with warfarin for at least 4 weeks pre- and immediately postprocedure and were bridged with enoxaparin. Transesophageal echocardiography was performed within 24 hours prior to ablation in all cases. Results: Periprocedural CVA occurred in 10 of 721 cases (1.4%). The risk of periprocedural CVA did not vary significantly during the course of the study. Among these 10 patients (age 62 ± 11 years; 1 female; 5 persistent AF), 6 manifested neurological deficits within 24 hours, 3 after 24-48 hours, and 1 patient had a CVA 6 days following AF ablation despite a therapeutic INR level. All CVAs were ischemic. Five patients had residual deficits after 30 days. Four of 43 patients (9.3%) with a prior history of CVA had periprocedural CVA. Periprocedural CVA occurred in 0.3%, 1.0%, and 4.7% of patients with CHADS 2 scores of 0, 1, and ≥ 2 (P < 0.001). In 2 separate multivariate analyses, a CHADS2 score ≥ 2 (OR 7.1, P = 0.02) and history of CVA (OR 9.5, P < 0.01) remained independent predictors of periprocedural CVA. Conclusions: Despite periprocedural anticoagulation and transesophageal echocardiography, we found a 1.4% incidence of periprocedural CVA in AF ablation patients. A CHADS2 score ≥ 2 and a history of CVA are independent predictors of CVA after AF ablation. The CVA risk is low in patients with CHADS2 score of 0. (J Cardiovasc Electrophysiol, Vol. 20, pp. 1357-1363, December 2009)
AB - Periprocedural CVA in AF Ablation. Background: Cerebrovascular accident (CVA) is a serious complication of catheter ablation of atrial fibrillation (AF). The incidence and clinical predictors of periprocedural CVA in patients undergoing AF ablation are not fully understood. Methods: This study included 721 cases (age 57 ± 11 years; 23% female; 345 persistent AF) in 579 consecutive patients referred for AF ablation. Periprocedural CVA was defined as onset of a new neurologic deficit that occurred anytime between the start of the procedure and 30 days after the AF ablation, and was confirmed by a neurologist. Cranial imaging with CT and/or MRI was performed in each case. Patients were anticoagulated with warfarin for at least 4 weeks pre- and immediately postprocedure and were bridged with enoxaparin. Transesophageal echocardiography was performed within 24 hours prior to ablation in all cases. Results: Periprocedural CVA occurred in 10 of 721 cases (1.4%). The risk of periprocedural CVA did not vary significantly during the course of the study. Among these 10 patients (age 62 ± 11 years; 1 female; 5 persistent AF), 6 manifested neurological deficits within 24 hours, 3 after 24-48 hours, and 1 patient had a CVA 6 days following AF ablation despite a therapeutic INR level. All CVAs were ischemic. Five patients had residual deficits after 30 days. Four of 43 patients (9.3%) with a prior history of CVA had periprocedural CVA. Periprocedural CVA occurred in 0.3%, 1.0%, and 4.7% of patients with CHADS 2 scores of 0, 1, and ≥ 2 (P < 0.001). In 2 separate multivariate analyses, a CHADS2 score ≥ 2 (OR 7.1, P = 0.02) and history of CVA (OR 9.5, P < 0.01) remained independent predictors of periprocedural CVA. Conclusions: Despite periprocedural anticoagulation and transesophageal echocardiography, we found a 1.4% incidence of periprocedural CVA in AF ablation patients. A CHADS2 score ≥ 2 and a history of CVA are independent predictors of CVA after AF ablation. The CVA risk is low in patients with CHADS2 score of 0. (J Cardiovasc Electrophysiol, Vol. 20, pp. 1357-1363, December 2009)
KW - Ablation
KW - Atrial fibrillation
KW - Cerebrovascular accident
KW - Complication
KW - Embolism
KW - Warfarin
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U2 - 10.1111/j.1540-8167.2009.01540.x
DO - 10.1111/j.1540-8167.2009.01540.x
M3 - Article
C2 - 19572951
AN - SCOPUS:70450217281
SN - 1045-3873
VL - 20
SP - 1357
EP - 1363
JO - Journal of cardiovascular electrophysiology
JF - Journal of cardiovascular electrophysiology
IS - 12
ER -