Incidence and predictors of periprocedural cerebrovascular accident in patients undergoing catheter ablation of atrial fibrillation

Daniel Scherr, Kavita Sharma, Darshan Dalal, David D Spragg, Karuna Chilukuri, Alan Cheng, Jun Dong, Charles A. Henrikson, Saman Nazarian, Ronald D Berger, Hugh Calkins, Joseph Marine

Research output: Contribution to journalArticle

Abstract

Periprocedural CVA in AF Ablation. 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 CHADS2 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 CHADS2 score ≥ 2 and a history of CVA are independent predictors of CVA after AF ablation. The CVA risk is low in patients with CHADS2 score of 0. (J Cardiovasc Electrophysiol, Vol. 20, pp. 1357-1363, December 2009)

Original languageEnglish (US)
Pages (from-to)1357-1363
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Volume20
Issue number12
DOIs
StatePublished - Dec 2009

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Catheter Ablation
Atrial Fibrillation
Stroke
Incidence
Transesophageal Echocardiography
Enoxaparin
International Normalized Ratio
Warfarin
Neurologic Manifestations

Keywords

  • Ablation
  • Atrial fibrillation
  • Cerebrovascular accident
  • Complication
  • Embolism
  • Warfarin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Incidence and predictors of periprocedural cerebrovascular accident in patients undergoing catheter ablation of atrial fibrillation. / Scherr, Daniel; Sharma, Kavita; Dalal, Darshan; Spragg, David D; Chilukuri, Karuna; Cheng, Alan; Dong, Jun; Henrikson, Charles A.; Nazarian, Saman; Berger, Ronald D; Calkins, Hugh; Marine, Joseph.

In: Journal of Cardiovascular Electrophysiology, Vol. 20, No. 12, 12.2009, p. 1357-1363.

Research output: Contribution to journalArticle

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AU - Scherr, Daniel

AU - Sharma, Kavita

AU - Dalal, Darshan

AU - Spragg, David D

AU - Chilukuri, Karuna

AU - Cheng, Alan

AU - Dong, Jun

AU - Henrikson, Charles A.

AU - Nazarian, Saman

AU - Berger, Ronald D

AU - Calkins, Hugh

AU - Marine, Joseph

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N2 - Periprocedural CVA in AF Ablation. 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 CHADS2 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 CHADS2 score ≥ 2 and a history of CVA are independent predictors of CVA after AF ablation. The CVA risk is low in patients with CHADS2 score of 0. (J Cardiovasc Electrophysiol, Vol. 20, pp. 1357-1363, December 2009)

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KW - Atrial fibrillation

KW - Cerebrovascular accident

KW - Complication

KW - Embolism

KW - Warfarin

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