Safety of Catheter Ablation for Atrial Fibrillation in Patients With Prior Cerebrovascular Events

Ayman A Hussein; Abhishek Gadre; Oussama M Wazni; Walid I Saliba; Mohammed Bassiouny; Khaldoun Tarakji; Bryan Baranowski; Mina Chung; Mandeep Bhargava; Thomas Callahan; Daniel Cantillon; Thomas Dresing; Patrick Tchou; Mark Niebauer; Mohamed Kanj; Bruce D Lindsay; Niraj Varma

doi:10.1016/j.jacep.2015.10.009

Safety of Catheter Ablation for Atrial Fibrillation in Patients With Prior Cerebrovascular Events

JACC Clin Electrophysiol. 2016 Apr;2(2):162-169. doi: 10.1016/j.jacep.2015.10.009. Epub 2015 Nov 17.

Authors

Ayman A Hussein¹, Abhishek Gadre¹, Oussama M Wazni¹, Walid I Saliba¹, Mohammed Bassiouny¹, Khaldoun Tarakji¹, Bryan Baranowski¹, Mina Chung¹, Mandeep Bhargava¹, Thomas Callahan¹, Daniel Cantillon¹, Thomas Dresing¹, Patrick Tchou¹, Mark Niebauer¹, Mohamed Kanj¹, Bruce D Lindsay¹, Niraj Varma²

Affiliations

¹ Center for Atrial Fibrillation, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
² Center for Atrial Fibrillation, Cleveland Clinic Foundation, Cleveland, Ohio, USA. Electronic address: varman@ccf.org.

PMID: 29766866
DOI: 10.1016/j.jacep.2015.10.009

Abstract

Objectives: This study sought to report on the safety of catheter ablation for atrial fibrillation (AF) in patients with prior cerebrovascular events (CVEs), at a large-volume tertiary care center over the course of the past 15 years.

Background: Many patients with drug-refractory AF have a history of a prior CVE. These patients are considered to be at high procedural risk for catheter ablation but data are scant.

Methods: All consecutive patients undergoing AF ablation at the Cleveland Clinic were enrolled in a prospectively maintained data registry, which was used to identify patients with a prior CVE. Strict periprocedural anticoagulation protocols were in place. Extreme care was taken with sheath and catheter manipulation to prevent thrombus formation or air embolism. All thromboembolic and hemorrhagic events occurring periprocedurally and up to 3 months of follow-up were identified.

Results: Of 9,413 consecutive patients who underwent AF ablation, 247 patients with a prior CVE were identified (median age, 64 years; 40.1% female; median CHA2DS2-VASC score, 4). Anticoagulants used were warfarin (n = 192), dabigatran (n = 32), rivaroxaban (n = 15), and apixaban (n = 8). All patients received intravenous heparin before transseptal access (activated clotting time target during procedure, 350 to 400 seconds). The energy source was radiofrequency in 242 patients and cryoenergy in 5 patients. Acute procedural complications included 5 groin hematomas (1 requiring transfusion), 5 pericardial effusions with associated tamponade physiology in 2 (1 required pericardiocenthesis, 1 required surgery), and 1 arteriovenous fistula (managed conservatively). Importantly, none of the patients had a periprocedural thromboembolic event.

Conclusions: Patients with a prior history of cerebrovascular events do not seem to be predisposed to a significant risk of clinical CVE recurrence when undergoing catheter ablation for AF without interruption of therapeutic anticoagulation.

Keywords: atrial fibrillation; catheter ablation; stroke.