Risk of Thromboembolic Events After Percutaneous Left Atrial Radiofrequency Ablation of Atrial Fibrillation

Abstract

Background-In patients with atrial fibrillation (AF), the risk of thromboembolic events (TEs) is variable and is influencedby the presence and number of comorbid conditions. The effect of percutaneous left atrial radiofrequency ablation (LARFA) of AF on the risk of TEs is unclear. Methods and Results-LARFA was performed in 755 consecutive patients with paroxysmal (nϭ490) or chronic (nϭ265) AF. Four hundred eleven patients (56%) had Ն1 risk factor for stroke. All patients were anticoagulated with warfarin for Ն3 months after LARFA. A TE occurred in 7 patients (0.9%) within 2 weeks of LARFA. A late TE occurred 6 to 10 months after ablation in 2 patients (0.2%), 1 of whom still had AF, despite therapeutic anticoagulation in both. Among 522 patients who remained in sinus rhythm after LARFA, warfarin was discontinued in 79% of 256 patients without risk factors and in 68% of 266 patients with Ն1 risk factor. Patients older than 65 years or with a history of stroke were more likely to remain anticoagulated despite a successful outcome from LARFA. None of the patients in whom anticoagulation was discontinued had a TE during 25Ϯ8 months of follow-up. Conclusions-The risk of a TE after LARFA is 1.1%, with most events occurring within 2 weeks after the procedure.Discontinuation of anticoagulant therapy appears to be safe after successful LARFA, both in patients without risk factors for stroke and in patients with risk factors other than age Ͼ65 years and history of stroke. Sufficient safety data are as yet unavailable to support discontinuation of anticoagulation in patients older than 65 years or with a history of stroke.

Causes and Predictors of Readmission in Patients With Atrial Fibrillation Undergoing Catheter Ablation: A National Population‐Based Cohort Study

“…High heart failure rate in readmitted subjects in our study compared with Noseworthy et al13 is partly explained by the greater proportion of subjects aged ≥65 years in our study. Readmission rate because of stroke/TIA and bleeding noted in our study is similar to previously published studies 17, 20, 21, 22…”

Stroke in Atrial Fibrillation – Long-term Follow-up of Cardiovascular Events

“…Several studies have reported the rate of TE events after AF ablation, which are summarised in Table 1. [29][30][31][32][33] Although these studies differed in patients' CHADS 2 scores, strategy of the use of anti-thrombotic agents and ablation procedures, the annual rate of systemic thromboembolisms was lower than 1 % in these investigations. Recurrence of atrial arrhythmias after catheter ablation was an important predictor of TE events, and maintenance of sinus rhythm was beneficial.…”

Efficacy of multi-electrode duty-cycled radiofrequency ablation in patients with paroxysmal and persistent atrial fibrillation

“…The incidence of thrombo-embolism associated with AF ablation is reported to be between 0% and 7% [1,[19][20][21][22][23]. The rate of cardiac tamponade reported in Updated Worldwide Survey on the Methods, Efficacy, and Safety of Catheter Ablation for Human Atrial Fibrillation is 1.3% [24].…”