Incidence and predictors of silent cerebral thromboembolic lesions after catheter ablation for atrial fibrillation in patients treated with direct oral anticoagulants

Abstract

There are few reports about the incidence and predictors of silent cerebral thromboembolic lesions (SCLs) after atrial fibrillation (AF) ablation in patients treated with direct oral anticoagulants (DOACs). The purpose of this study is to evaluate the incidence and predictors of SCLs after AF ablation with cerebral magnetic resonance imaging (C-MRI) in patients treated with DOACs. We enrolled 117 consecutive patients who underwent first AF ablation and received DOACs, including apixaban, dabigatran, edoxaban, and rivaroxaban. DOACs were discontinued after administration 24 h before the procedure, and restarted 6 h after the procedure. During the procedure, activated clotting time (ACT) was measured every 15 min, and intravenous heparin infusion was performed to maintain ACT at 300-350 s. All patients underwent C-MRI the day after the procedure. SCLs were detected in 28 patients (24%) after AF ablation. Age, female sex, the presence of persistent AF, left atrial volume, procedure time, radiofrequency energy, electrical cardioversion, and mean ACT showed no correlations with the incidence of SCLs. Multivariate analysis revealed independent predictors of SCLs were CHADSVASc scores ≥3, left atrial appendage (LAA) emptying velocity ≤39 cm/s, and minimum ACT ≤260 s. Patients with both CHADSVASc scores ≥3 and LAA flow velocity ≤39 cm/s had the highest incidence of SCLs 15 of 26 patients (58%). In patients treated with DOACs, CHADSVASc score ≥3, minimum ACT ≤260 s, and LAA emptying velocity ≤39 cm/s were independent risk factors for the SCLs after AF ablation.

Silent cerebral lesions and cognitive function after pulmonary vein isolation with an irrigated gold‐tip catheter: REDUCE‐TE Pilot study

“…Intraprocedurally, the ACT management was suboptimal in a considerable number of patients, with ACT values less than 300 seconds. Univariate analysis identified a trend towards a higher likelihood for SCLs in patients with lower ACT values (<250 seconds), which is in accordance with previous observations . This again highlights the importance of proper anticoagulation management during the ablation procedure.…”

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

“…The incidence of SCEs in group C was 18.1% in the entire cohort and 10.0% in the matched‐pair group, respectively, and was similar to that reported in the previous studies with an RF‐based AF ablation guided by the CARTO system in the patients receiving periprocedural anticoagulation with uninterrupted warfarin and uninterrupted or minimally interrupted DOACs (0%–26.7%) 2‐4,8‐10 . 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.…”

“…Some predictors of SCEs after AF ablation have been reported, such as an older age, 7 nonparoxysmal AF, 5,11 higher CHA 2 DS 2 -VASc score, 9 reduced LA appendage flow velocity, 9 presence of spontaneous echo contrast, 7 lower ACT level, 5,9 extensive LA ablation, 7 and cardioversion during the procedure. 10 Nonparoxysmal AF was an independent positive predictor of SCEs in the present study, which was consistent with the results in the previous studies.…”

Efficacy and safety of uninterrupted low-intensity warfarin for cryoballoon ablation of atrial fibrillation in the elderly: A pilot study

“…It was 17.5% when warfarin was interrupted during the periprocedural period. Recently, Doi A et al found that CHA2DS2‐VASc score and minimal ACT during the procedure were independent predictors of ACE. These results indicate that thromboembolism is an important mechanism of ACE.…”