Periprocedural Stroke and Management of Major Bleeding Complications in Patients Undergoing Catheter Ablation of Atrial Fibrillation

被引：237

作者：

Di Biase, Luigi ^{[1
,2
,3
]}

Burkhardt, J. David ^{[1
]}

Mohanty, Prasant ^{[1
]}

Sanchez, Javier ^{[1
]}

Horton, Rodney ^{[1
,3
,6
]}

Gallinghouse, G. Joseph ^{[1
]}

Lakkireddy, Dhanunjay ^{[4
]}

Verma, Atul ^{[5
]}

Khaykin, Yaariv ^{[5
]}

Hongo, Richard

Hao, Steven ^{[6
]}

Beheiry, Salwa ^{[6
]}

Pelargonio, Gemma ^{[7
]}

Dello Russo, Antonio ^{[7
]}

Casella, Michela ^{[7
]}

Santarelli, Pietro ^{[7
]}

Santangeli, Pasquale ^{[7
]}

Wang, Paul ^{[8
]}

Al-Ahmad, Amin ^{[8
]}

Patel, Dimpi ^{[1
]}

Themistoclakis, Sakis ^{[9
]}

Bonso, Aldo ^{[9
]}

Rossillo, Antonio ^{[9
]}

Corrado, Andrea ^{[9
]}

Raviele, Antonio ^{[9
]}

Cummings, Jennifer E. ^{[10
]}

Schweikert, Robert A. ^{[10
]}

Lewis, William R. ^{[11
]}

Natale, Andrea ^{[1
,3
,6
,8
,11
]}

机构：

[1] St Davids Med Ctr, Texas Cardiac Arrhythmia Inst, Austin, TX 78705 USA

[2] Univ Foggia, Dept Cardiol, Foggia, Italy

[3] Univ Texas Austin, Dept Biomed Engn, Austin, TX 78712 USA

[4] Univ Kansas, Lawrence, KS USA

[5] Southlake Reg Hlth Ctr, New Market, ON, Canada

[6] Calif Pacific Med Ctr, San Francisco, CA USA

[7] Catholic Univ, Rome, Italy

[8] Stanford Univ, Palo Alto, CA 94304 USA

[9] Hosp Angelo, Mestre Venice, Italy

[10] Akron Gen Hosp, Akron, OH USA

[11] Case Western Reserve Univ, Sch Med, Cleveland, OH 44106 USA

来源：

CIRCULATION | 2010年 / 121卷 / 23期

关键词：

atrial fibrillation; catheter ablation; embolism; stroke; transient ischemic attack; warfarin; INTERNATIONAL NORMALIZED RATIO; VEIN ANTRUM ISOLATION; INTRACARDIAC ECHOCARDIOGRAPHY; RADIOFREQUENCY ABLATION; ELECTRICAL ISOLATION; ANTICOAGULATION; STRATEGIES; IMPACT;

D O I：

10.1161/CIRCULATIONAHA.109.921320

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background-Catheter ablation of atrial fibrillation is associated with the potential risk of periprocedural stroke, which can range between 1% and 5%. We developed a prospective database to evaluate the prevalence of stroke over time and to assess whether the periprocedural anticoagulation strategy and use of open irrigation ablation catheter have resulted in a reduction of this complication. Methods and Results-We collected data from 9 centers performing the same ablation procedure with the same anticoagulation protocol. We divided the patients into 3 groups: ablation with an 8-mm catheter off warfarin (group 1), ablation with an open irrigated catheter off warfarin (group 2), and ablation with an open irrigated catheter on warfarin (group 3). Outcome data on stroke/transient ischemic attack and bleeding complications during and early after the procedures were collected. Of 6454 consecutive patients in the study, 2488 were in group 1, 1348 were in group 2, and 2618 were in group 3. Periprocedural stroke/transient ischemic attack occurred in 27 patients (1.1%) in group 1 and 12 patients (0.9%) in group 2. Despite a higher prevalence of nonparoxysmal atrial fibrillation and more patients with CHADS2 (congestive heart failure, hypertension, age >75 years, diabetes mellitus, and prior stroke or transient ischemic attack) score >2, no stroke/transient ischemic attack was reported in group 3. Complications among groups 1, 2, and 3, including major bleeding (10 [0.4%], 11 [0.8%], and 10 [0.4%], respectively; P>0.05) and pericardial effusion (11 [0.4%], 11 [0.8%], and 12 [0.5%]; P>0.05), were equally distributed. Conclusion-The combination of an open irrigation ablation catheter and periprocedural therapeutic anticoagulation with warfarin may reduce the risk of periprocedural stroke without increasing the risk of pericardial effusion or other bleeding complications. (Circulation. 2010; 121: 2550-2556.)

引用

页码：2550 / 2556

页数：7

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