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Safety of catheter ablation for atrial fibrillation in patients with intracranial hemorrhage

Sicherheit der Katheterablation wegen Vorhofflimmern bei Patienten mit intrakranieller Blutung

Abstract

Background

The safety of anticoagulation and radiofrequency catheter ablation (RFCA) in patients with atrial fibrillation (AF) and a history of intracranial hemorrhage (ICH) remains unclear. We investigated the risks and benefits of this approach in AF patients with a history of ICH.

Patients and methods

The ICH group included 45 AF patients with a history of ICH who underwent RFCA. Five of these patients were excluded because ICH occurred spontaneously after cerebral infarction. The control group included 80 individuals who presented for AF ablation and did not have a history of ICH. Two controls were matched for each study group patient in terms of sex, age (±2 years), type of AF, and procedure date.

Results

Patients in the ICH group had higher CHADS2 (1.7 ± 1.3 vs. 1.1 ± 1.2, p < 0.05), CHA2DS2-VASc (2.6 ± 1.7 vs. 1.9 ± 1.6, p < 0.05), and HAS-BLED scores (2.5 ± 1.0 vs. 1.1 ± 1.0, p < 0.001). All participants in both groups underwent successful RFCA. The incidence of ICH during follow-up (1 vs. 0, p = 0.333) was similar between the ICH and control groups. AF-free survival between the two groups was not significant (log-rank p = 0.283) within the first 3 months, but was significant (log-rank p = 0.011) within 48 months of RFCA. History of ICH was the only independent predictor of AF recurrence according to univariate Cox regression analysis.

Conclusion

In AF patients with a history of ICH, AF ablation with a standard anticoagulation strategy is safe and does not seem to be associated with an increased risk of hemorrhage.

Zusammenfassung

Hintergrund

Die Sicherheit der Antikoagulation und der Radiofrequenz-Katheterablation (RFCA) wegen Vorhofflimmern (VF) bei Patienten mit einer intrakraniellen Blutung in der Vorgeschichte bleibt unklar. Risiken und Vorteile dieser Therapie für VF-Patienten mit intrakranieller Blutung in der Anamnese werden untersucht.

Methoden

Zur Studiengruppe gehörten 45 VF-Patienten mit intrakranieller Blutung in der Anamnese, bei denen eine RFCA-Therapie erfolgte. Die Kontrollgruppe umfasste 80 Patienten ohne intrakranielle Blutung in der Vorgeschichte. Je 2 Patienten aus der Kontrollgruppe wurden einem Patienten aus der Studiengruppe in Bezug auf Geschlecht, Alter (±2 Jahre), AF-Typ und Operationszeitpunkt passend zugeordnet.

Ergebnisse

Patienten aus der Studiengruppe wiesen höhere CHADS2- (1,7 ± 1,3 vs. 1,1 ± 1,2; p < 0,05), CHA2DS2-VASc- (2,6 ± 1,7 vs. 1,9 ± 1,6; p < 0,05) und HAS-BLED-Werte auf (2,5 ± 1,0 vs. 1,1 ± 1,0; p < 0,001). Bei allen Teilnehmern aus beiden Gruppen war die RFCA erfolgreich durchgeführt worden. Die Inzidenz der intrakraniellen Blutung während der Nachbeobachtung (1 vs. 0; p = 0,333) war im Vergleich beider Gruppen ähnlich. Der Unterschied beim VF-freien Überleben zwischen den beiden Gruppen war innerhalb der ersten 3 Monate nicht signifikant (Log-Rank-Test: p = 0,283), innerhalb von 48 Monaten nach RFCA jedoch signifikant (Log-Rank-Test: p = 0,011). Eine intrakranielle Blutung in der Anamnese war der einzige unabhängige Indikator für die Prognose eines VF-Rezidivs gemäß univariater Cox-Regressionsanalyse.

Schlussfolgerung

Für VF-Patienten mit intrakranieller Blutung in der Anamnese ist die Katheterablation mit Standardantikoagulation sicher und führt nicht zu einem erhöhten Blutungsrisiko.

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Funding

This work was supported by grants from the National Science Foundation of China (grant nos. 81470464, 81530016), Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (ZYLX201302), Beijing Municipal Science & Technology Commission (D151100002215003 and D151100002215004), National Natural Science Foundation of China (81500254), and Excellent Talent of Beijing Program (2015000021469G195).

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Corresponding author

Correspondence to C.-S. Ma M.D., FHRS, FESC, FACC.

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Conflict of interest

H. Lin, S.-N. Li, R. Bai, S.-N. Wen, N. Liu, D.-Y. Long, R.-H. Yu, R.-B. Tang, C.-H. Sang, X. Du, J.-Z. Dong, and C.-S. Ma declare that they have no competing interests.

This study was reviewed and approved by the Ethics Committee of Anzhen Hospital, Beijing. All participants provided written informed consent prior to enrollment in the study.

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Lin, H., Li, SN., Bai, R. et al. Safety of catheter ablation for atrial fibrillation in patients with intracranial hemorrhage. Herz 43, 169–176 (2018). https://doi.org/10.1007/s00059-017-4551-8

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  • DOI: https://doi.org/10.1007/s00059-017-4551-8

Keywords

  • Atrial fibrillation
  • Radiofrequency catheter ablation
  • Intracranial hemorrhages
  • Anticoagulation agents
  • Heparin

Schlüsselwörter

  • Vorhofflimmern
  • Radiofrequenz-Katheterablation
  • Intrakranielle Blutung
  • Antikoagulation
  • Heparin