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Impact of periprocedural anticoagulation strategy on the incidence of new-onset silent cerebral events after radiofrequency catheter ablation of atrial fibrillation

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Abstract

Background

Silent cerebral events (SCEs) have been observed on diffusion-weighted cerebral magnetic resonance imaging (MRI) in a substantial number of asymptomatic patients after atrial fibrillation (AF) ablation procedures. The purpose of this study was to investigate if periprocedural oral anticoagulation (OAC) management affects the incidence of new-onset SCE after radiofrequency catheter ablation (RFCA) of AF.

Methods and results

One hundred ninety-two consecutive patients (64 ± 10.1 years, 38.5 % women) with symptomatic paroxysmal (n = 80, 41.7 %) or persistent AF undergoing RFCA of AF were prospectively enrolled. Periprocedural anticoagulation strategies were defined as uninterrupted use of novel oral anticoagulants (NOACs) (group I, n = 64), interrupted use of NOACs (group II, n = 42), continuation of vitamin K antagonist (VKA) with an international normalized ratio (INR) between 2.0 and 3.0 (group III, n = 43), and VKA discontinuation bridged with low molecular weight heparin (group IV, n = 43). Cerebral MRI was performed 1 to 2 days after RFCA for detection of new SCE. Overall, new SCEs were detected in 41 patients (21.4 %) after AF ablation. New SCEs were detected in 12.5 % in group I, 35.7 % in group II, 18.6 % in group III, and 23.3 % in group IV (p < 0.05). Multivariable logistic regression analysis revealed persistent AF and discontinuation of periprocedural OAC (group II and IV) to be independent predictors for the development of SCE. No relevant complications were identified.

Conclusions

Periprocedural continuation of NOAC as well as continuation of VKA seems to be safe and significantly reduce the occurrence of SCE after AF ablation.

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Abbreviations

ACT:

Activated clotting time

AF:

Atrial fibrillation

INR:

International normalized ratio

FLAIR:

Fluid-attenuated inversion recovery

LMH:

Low-molecular weight heparin

LV-EF:

Left ventricular ejection fraction

MRI:

Diffusion-weighted magnetic resonance imaging

NOAC:

Novel/newer oral anticoagulant

OAC:

Oral anticoagulation

PVI:

Pulmonary vein isolation

RFCA:

Radiofrequency catheter ablation

SCE:

Silent cerebral event

SCL:

Silent cerebral lesion

TIA:

Transient ischemic attack

UFH:

Unfractionated heparin

VKA:

Vitamin K antagonist

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Authors and Affiliations

  1. Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Bavaria, Germany

    Patrick Müller, Philipp Halbfass, Attila Szöllösi, Franziska Fochler, Karin Nentwich, Markus Roos, Joachim Krug & Thomas Deneke

  2. Heart Center Bad Neustadt, Clinic for Radiology, Bad Neustadt an der Saale, Bavaria, Germany

    Rainer Schmitt

  3. University Hospital Bergmannsheil, Clinic for Cardiology and Angiology, Ruhr-University Bochum, Bochum, NRW, Germany

    Johannes-Wolfgang Dietrich, Andreas Mügge & Thomas Deneke

  4. University Hospital Düsseldorf, Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany

    Patrick Müller

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  1. Patrick Müller
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Correspondence to Patrick Müller.

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All authors declare that they have no conflict of interest.

Human rights statements and informed consent: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000(5). Informed consent was obtained from all patients for being included in this study.

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P. Müller and P. Halbfass contributed equally to this work and share first authorship.

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Müller, P., Halbfass, P., Szöllösi, A. et al. Impact of periprocedural anticoagulation strategy on the incidence of new-onset silent cerebral events after radiofrequency catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 46, 203–211 (2016). https://doi.org/10.1007/s10840-016-0117-6

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