Introduction: Silent thromboembolic lesion (STL) as detected by diffusion cerebral magnetic resonance imaging (dMRI) following catheter ablation of atrial fibrillation (AF) with open irrigated radiofrequency energy (RF) has been reported in 14% of the cases while performing the procedure with warfarin discontinuation. We sought to determine the prevalence of STL while performing AF ablation without warfarin discontinuation with open irrigated RF energy. Methods: Consecutive patients undergoing RF ablation for AF with "therapeutic" warfarin and undergoing heparin bolus before transseptal were included in this prospective multicenter study. All patients underwent pre-ablation and pos-ablation (within 24 hours) dMRI. All patients had to maintain ACT above 300 secs during the entire procedure. During the ablation if sinus rhythm could not be achieved, electrical cardioversion was utilized to restore sinus rhythm. Results: 146 patients (62±9 years, 74% male, paroxysmal 25%, persistent 30%, long-standing persistent 45%, CHADS ≥2 11%) were included. The mean INR was 2.5±0.3. Pre and post-procedural dMRI was obtained in all cases. Sinus rhythm was restored with cardioversion in 35 pts (24%) of the cases. The incidence of post-ablation STL was 2.1% in overall population. When sorting the results by AF type we found that it was 0% (0/37) in paroxysmal patients, 0% in PER pts (0/43) and 4.5% in LSP pts (3/66). At multivariable analysis cardioversion did not show prognostic association with STL (odds ratio 1.9 (0.30 to 13.11), p=.48). All pts with STL had a single brain lesion less < 5 mm. Conclusion: This study shows that if catheter ablation of AF is performed under "therapeutic" warfarin the risk of STL is limited to patients with LSP where extensive ablation was performed. In addition lesions were small and did not correlate with cardioversion.
Cerebral magnetic resonance imaging (dMRI) pre and 24 hour after catheter ablation of AF under therapeutic warfarin: prevalence of silent thromboembolic lesion from a from a multicenter study
GAITA, Fiorenzo;ANSELMINO, Matteo;
2013-01-01
Abstract
Introduction: Silent thromboembolic lesion (STL) as detected by diffusion cerebral magnetic resonance imaging (dMRI) following catheter ablation of atrial fibrillation (AF) with open irrigated radiofrequency energy (RF) has been reported in 14% of the cases while performing the procedure with warfarin discontinuation. We sought to determine the prevalence of STL while performing AF ablation without warfarin discontinuation with open irrigated RF energy. Methods: Consecutive patients undergoing RF ablation for AF with "therapeutic" warfarin and undergoing heparin bolus before transseptal were included in this prospective multicenter study. All patients underwent pre-ablation and pos-ablation (within 24 hours) dMRI. All patients had to maintain ACT above 300 secs during the entire procedure. During the ablation if sinus rhythm could not be achieved, electrical cardioversion was utilized to restore sinus rhythm. Results: 146 patients (62±9 years, 74% male, paroxysmal 25%, persistent 30%, long-standing persistent 45%, CHADS ≥2 11%) were included. The mean INR was 2.5±0.3. Pre and post-procedural dMRI was obtained in all cases. Sinus rhythm was restored with cardioversion in 35 pts (24%) of the cases. The incidence of post-ablation STL was 2.1% in overall population. When sorting the results by AF type we found that it was 0% (0/37) in paroxysmal patients, 0% in PER pts (0/43) and 4.5% in LSP pts (3/66). At multivariable analysis cardioversion did not show prognostic association with STL (odds ratio 1.9 (0.30 to 13.11), p=.48). All pts with STL had a single brain lesion less < 5 mm. Conclusion: This study shows that if catheter ablation of AF is performed under "therapeutic" warfarin the risk of STL is limited to patients with LSP where extensive ablation was performed. In addition lesions were small and did not correlate with cardioversion.
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