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Incidence and Predictors of Periprocedural Cerebrovascular Accident in Patients Undergoing Catheter Ablation of Atrial Fibrillation
Author(s) -
SCHERR DANIEL,
SHARMA KAVITA,
DALAL DARSHAN,
SPRAGG DAVID,
CHILUKURI KARUNA,
CHENG ALAN,
DONG JUN,
HENRIKSON CHARLES A.,
NAZARIAN SAMAN,
BERGER RONALD D.,
CALKINS HUGH,
MARINE JOSEPH E.
Publication year - 2009
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2009.01540.x
Subject(s) - medicine , atrial fibrillation , catheter ablation , cardiology , incidence (geometry) , ablation , stroke (engine) , catheter , surgery , mechanical engineering , physics , optics , engineering
Background:Cerebrovascular accident (CVA) is a serious complication of catheter ablation of atrial fibrillation (AF). The incidence and clinical predictors of periprocedural CVA in patients undergoing AF ablation are not fully understood.Methods:This study included 721 cases (age 57 ± 11 years; 23% female; 345 persistent AF) in 579 consecutive patients referred for AF ablation. Periprocedural CVA was defined as onset of a new neurologic deficit that occurred anytime between the start of the procedure and 30 days after the AF ablation, and was confirmed by a neurologist. Cranial imaging with CT and/or MRI was performed in each case. Patients were anticoagulated with warfarin for at least 4 weeks pre‐ and immediately postprocedure and were bridged with enoxaparin. Transesophageal echocardiography was performed within 24 hours prior to ablation in all cases.Results:Periprocedural CVA occurred in 10 of 721 cases (1.4%). The risk of periprocedural CVA did not vary significantly during the course of the study. Among these 10 patients (age 62 ± 11 years; 1 female; 5 persistent AF), 6 manifested neurological deficits within 24 hours, 3 after 24–48 hours, and 1 patient had a CVA 6 days following AF ablation despite a therapeutic INR level. All CVAs were ischemic. Five patients had residual deficits after 30 days. Four of 43 patients (9.3%) with a prior history of CVA had periprocedural CVA. Periprocedural CVA occurred in 0.3%, 1.0%, and 4.7% of patients with CHADS 2 scores of 0, 1, and ≥ 2 (P < 0.001). In 2 separate multivariate analyses, a CHADS 2 score ≥ 2 (OR 7.1, P = 0.02) and history of CVA (OR 9.5, P < 0.01) remained independent predictors of periprocedural CVA.Conclusions:Despite periprocedural anticoagulation and transesophageal echocardiography, we found a 1.4% incidence of periprocedural CVA in AF ablation patients. A CHADS 2 score ≥ 2 and a history of CVA are independent predictors of CVA after AF ablation. The CVA risk is low in patients with CHADS 2 score of 0.