Impact of the type of electroanatomic mapping system on the incidence of cerebral embolism after radiofrequency catheter ablation of left atrial tachycardias

Nakamura, Kohki; Sasaki, Takehito; Take, Yutaka; Minami, Kentaro; Inoue, Mitsuho; Kishi, Shohei; Yoshimura, Shingo; Sasaki, Wataru; Okazaki, Yoshimasa; Motoda, Hiroyuki; Niijima, Katsura; Miki, Yuko; Goto, Koji; Yamashita, Eiji; Koyama, Keiko; Funabashi, Nobusada; Naito, Shigeto

doi:10.1016/j.hrthm.2019.09.009

Cited by 15 publications

(24 citation statements)

References 22 publications

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“…15,16 Two identi ed studies were excluded due to lack of comparative data. 17,18 See eFigure 1 in the Supplement. The 3 randomized studies were critically appraised by using the Risk of Bias 2.0 Scale, and the 2 observational studies were appraised by using the Newcastle-Ottawa Scale (eTable 1 in the Supplement).…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, there is a hypothesis that dabigatran downregulates expression of antithrombin, with a compensatory prothrombin upregulation leading to diminution of unfractionated heparin effect. 18 Müller et al 15 reported greater incidence of asymptomatic, magnetic resonance imaging (MRI)-detected, so-called SCE in the IA group. At 1 to 2 days after radiofrequency catheter ablation, MRI was done by using a 1.5 Tesla MRI scanner.…”

Section: Thrombosis Riskmentioning

confidence: 99%

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Outcomes of Uninterrupted vs Interrupted Periprocedural Direct Oral Anticoagulants in Atrial Fibrillation Ablation: A Meta-Analysis

Basu‐Ray

Khanra

Kupó

et al. 2020

Preprint

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BACKGROUND: Studies indicate that uninterrupted anticoagulation is superior to interrupted anticoagulation in the periprocedural period during catheter ablation of atrial fibrillation and has better thromboembolic and hemorrhagic outcomes. Conversely, the few studies addressing the safety and efficacy of interrupted direct oral anticoagulant regimens during catheter ablation of atrial fibrillation are limited by small samples, short follow-up periods, rare events, and variable outcomes. The purpose of this meta-analysis was to compare interrupted and uninterrupted direct oral anticoagulation during catheter ablation of atrial fibrillation.METHODS: A systematic search into PubMed, EMBASE, and the Cochrane databases were performed and five studies were selected that directly that directly compared interrupted versus uninterrupted anticoagulation before ablation and reported procedural outcomes and embolic and bleeding events. The primary outcome of the study was major adverse cerebrocardiovascular events which was a composite of stroke/ transient ischemic attacks and major bleedings, total bleeding which was a composite of major and minor bleedings and silent cerebral events.RESULTS The meta-analysis included 840 patients with uninterrupted anticoagulation and 938 patients with interrupted anticoagulation. Median follow-up was 30 days. Baseline parameters were similar between groups. Activated clotting time before first heparin bolus was significantly longer with uninterrupted anticoagulation (P=.006), whereas mean activated clotting time was similar between the 2 groups (P=.19). Total heparin dose needed was significantly higher with interrupted anticoagulation (mean, ‒1.61; 95% CI, ‒2.67 to ‒0.55; P=.003). Mean procedure time did not vary between groups (P=.81). Overall complication rates were low, with similar major adverse cerebrocardiovascular event (P=.40) and total bleeding (P=.55) rates between groups. Silent cerebral events were significantly more frequent with interrupted anticoagulation (log odds ratio, ‒0.90; 95% CI, ‒1.59 to ‒0.22; P<.01; I2, 33%). Rates of major bleeding, minor bleeding, pericardial effusion, cardiac tamponade, and puncture complications were similar between groups.CONCLUSIONS Uninterrupted anticoagulation during atrial fibrillation ablation has similar bleeding event rates, procedural times, and mean activated clotting times as interrupted anticoagulation, with fewer silent cerebral events.

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Section: Resultsmentioning

confidence: 99%

Section: Thrombosis Riskmentioning

confidence: 99%

Outcomes of Uninterrupted vs Interrupted Periprocedural Direct Oral Anticoagulants in Atrial Fibrillation Ablation: A Meta-Analysis

Basu‐Ray

Khanra

Kupó

et al. 2020

Preprint

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“…On the other hand, the incidence of SCEs in Group R was 55.7% in the entire cohort and 51.7% in the matched‐pair group, respectively, and was much higher than that in Group C and those previous studies. We previously demonstrated that a left AT ablation guided by the Rhythmia system using a mini‐basket catheter and circular mapping catheter had a higher incidence of SCEs than that guided by the CARTO system using a multispline catheter (Pentaray catheter; Biosense Webster) and circular mapping catheter (86.2% vs. 33.3%; p < .001) 21 . In that previous study, propensity score matching based on the baseline characteristics was not conducted, and a total of four types of irrigated ablation catheters were used with the 3D‐EAM systems.…”

Section: Discussionmentioning

confidence: 99%

“…The RF catheter ablation procedures have been previously described in detail. 20,21 Three transseptal sheaths (SL0 or Agilis NxT; Abbott or ZURPAZ; Boston Scientific) were advanced into the left atrium (LA) over one transseptal puncture site, and an ablation catheter and two multielectrode mapping catheters were introduced into the LA through the sheaths. The transseptal sheaths were slowly flushed with heparinized saline when all catheters were inserted into the sheaths but were not continuously infused with heparinized saline.…”

Section: Rf Catheter Ablationmentioning

confidence: 99%

Incidence and characteristics of silent cerebral embolisms after radiofrequency‐based atrial fibrillation ablation: A propensity score‐matched analysis between different mapping catheters and indices for guiding ablation

Nakamura

Sasaki

Take

et al. 2020

Cardiovasc electrophysiol

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Introduction:The difference in the incidence and characteristics of silent cerebral events (SCEs) after radiofrequency-based atrial fibrillation (AF) ablation between the different mapping catheters and indices used for guiding radiofrequency ablation remains unclear. This study aimed to compare the incidence and characteristics of postablation SCEs between the following two groups: Group C, Ablation Index-guided ablation using two circular mapping catheters with CARTO (Biosense Webster); Group R, local impedance-guided ablation using one mini-basket catheter and one circular mapping with Rhythmia (Boston Scientific).Methods and Results: Of 211 consecutive patients who underwent an AF ablation and brain magnetic resonance (MR) imaging after the ablation, 120 patients (each group, n = 60) were selected by propensity score matching. SCEs were detected in 37 patients (30.8%). Group R had a higher incidence of SCEs (51.7% vs. 10.0%; p < .001) and more SCEs per patient (median, 3 vs. 1, p = .028) than Group C. A multivariate analysis demonstrated that nonparoxysmal AF and being Group R were independent positive predictors of SCEs (odds ratios, 6.930 and 15.464; both p < .001). On the follow-up MR imaging, all SCEs in Group C and 87.9% of the SCEs in Group R disappeared (p = .537).Conclusions: Group R had a significantly higher incidence of SCEs than Group C. Most probably the use of a complexly designed basket mapping catheter is the reason for the difference in the incidence of SCEs but further validation is needed. A nonparoxysmal form of AF may also increase the risk of SCEs during these ablation procedures.

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“…It is the credit of the authors to bring the attention of interventional electrophysiologists to the role of mapping catheters with a complex structural arrangement in the development of SCEs. In a previous study by the same group, the 3D‐EAM systems CARTO and Rhythmia were compared in the context of LA tachycardia ablation with a nearly identical result 4 . The strengths of the current study are: i) the large number of patients included, ii) the propensity score matching comparison, and finally, the rigorous postablation work‐up with brain MRI on the day after the procedure and again after around 4 weeks.…”

mentioning

confidence: 99%

Underrecognized consequence of three‐dimensional mapping tool selection for atrial fibrillation ablation: When the operators’ decision determines the amount of silent micro‐embolic burden

Rostock

Konrad

Spittler

2020

Cardiovasc electrophysiol

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Impact of the type of electroanatomic mapping system on the incidence of cerebral embolism after radiofrequency catheter ablation of left atrial tachycardias

Cited by 15 publications

References 22 publications

Outcomes of Uninterrupted vs Interrupted Periprocedural Direct Oral Anticoagulants in Atrial Fibrillation Ablation: A Meta-Analysis

Outcomes of Uninterrupted vs Interrupted Periprocedural Direct Oral Anticoagulants in Atrial Fibrillation Ablation: A Meta-Analysis

Incidence and characteristics of silent cerebral embolisms after radiofrequency‐based atrial fibrillation ablation: A propensity score‐matched analysis between different mapping catheters and indices for guiding ablation

Underrecognized consequence of three‐dimensional mapping tool selection for atrial fibrillation ablation: When the operators’ decision determines the amount of silent micro‐embolic burden

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