Delaying cardioversion following 4-week anticoagulation in case of persistent atrial fibrillation after a transcatheter ablation procedure to reduce silent cerebral thromboembolism

Abstract

Delaying electrical cardioversion after a 4-week anticoagulation period reduced the risk of silent cerebral thromboembolism and is a viable and safer option in patients terminating a transcatheter ablation procedure in atrial fibrillation.

Long‐Term Results of Transcatheter Atrial Fibrillation Ablation in Patients with Impaired Left Ventricular Systolic Function

“…31 This suggests that a switch to a rate control strategy should be considered for those patients who have already undergone multiple procedures and failed to maintain sinus rhythm. Only one symptomatic periprocedural transient ischemic attack was reported but the occurrence of silent cerebral ischemia, a finding complicating up to 14% of AF transcatheter ablations, 32,33 was not specifically investigated with cerebral magnetic resonance imaging. During follow-up, 2 strokes (one ischemic despite anticoagulation, one hemorrhagic) occurred.…”

Impact of Ablation Catheter Irrigation Design on Silent Cerebral Embolism After Radiofrequency Catheter Ablation of Atrial Fibrillation: Results from a Pilot Study

“…Then, the LA electroanatomic reconstruction was obtained by Carto 3 system (Biosense Webster) and merged with the 3D MRI reconstruction. The ablation procedure was performed in sinus rhythm while, in the case of AF appearance during the procedure or its persistence at the end of the ablation, cardioversion was postponed in the follow‐up after 1 month of effective oral anticoagulation 4–7 . After exclusion of pericardial effusion by postablation TTE, heparin infusion was started and titrated to maintain an activated partial thromboplastin time (aPTT) value of 60–80 seconds.…”

“…The ablation procedure was performed in sinus rhythm while, in the case of AF appearance during the procedure or its persistence at the end of the ablation, cardioversion was postponed in the follow-up after 1 month of effective oral anticoagulation. [4][5][6][7] After exclusion of pericardial effusion by postablation TTE, heparin infusion was started and titrated to maintain an activated partial thromboplastin time (aPTT) value of 60-80 seconds. The day after, the patient was discharged on LMWH twice daily (1 mg/kg) plus oral anticoagulation until an INR of more than 2 was reached.…”

Importance of anticoagulation and postablation silent cerebral lesions: Subanalyses of REVOLUTION and reMARQable studies

“…Although not explored in this report, other factors may contribute to the incidence of SCLs, including but not limited to energy sources or catheters used, procedure duration, handling of sheath, and timing of cardioversion . Protocol workflow modifications, such as delayed electrical cardioversion after 4‐week anticoagulation postablation, prevention of electrodes interaction, and careful sheath exchange to minimize air ingress, have been shown to reduce SCLs …”

“…19 Protocol workflow modifications, such as delayed electrical cardioversion after 4-week anticoagulation postablation, prevention of electrodes interaction, and careful sheath exchange to minimize air ingress, have been shown to reduce SCLs. 15,20 Study limitations: Both the SNA substudies were not powered to detect SCL differences between different ablation technologies. Factors other than anticoagulation contributing to SCL formation must be taken into consideration during AF ablation.…”