Asymptomatic Pulmonary Embolism after Ablation

Abstract

Background: Pulmonary embolism (PE) is a life-threatening event with a broad presentation spectrum ranging from asymptomatic cases to sudden cardiac arrest. It is unclear if right atrial emboli cause PE in patients with atrial fibrillation (AF) or if mild PE itself increases right cardiac pressure provoking AF. Objective: To determine the incidence and predictors of asymptomatic PE in patients undergoing AF ablation. Method and Results: Patients (n = 93) were screened and those with previous or current symptomatic PE or venous thromboembolism, pulmonary hypertension, increased right heart pressures detected on echocardiography, a history of stroke, transient ischemic attack, coagulopathy or cancer and inappropriate contrast for the evaluation of pulmonary arterial tree were excluded. The remaining AF patients (n = 71) underwent guided ablation controlled with 3-dimensional, left atrial and pulmonary venous computed tomography. The asymptomatic PE was defined by using the modified Miller score by 2 independent assessors in 6 patients. Univariate logistic regression showed that age (OR: 1.094, 95% CI 1.007-1.188, p = 0.033), diabetes (OR: 12.000, 95% CI 1.902-75.716, p = 0.008), CHA₂DS₂-VASc score (OR: 2.800, 95% CI 1.304-6.013, p = 0.008), and pulmonary artery diameter (OR: 1.221, 95% CI 1.033-1.444, p = 0.019) were significantly associated with PE. However, multivariate analysis revealed that the CHA₂DS₂-VASc score (p = 0.047) remained the exclusive significant predictor for asymptomatic PE. Conclusion: The incidence of random asymptomatic PE in AF patients is high (>8%). The CHA₂DS₂-VASc score can predict silent PE. Since patients with a high CHA₂DS₂-VASc score are already anticoagulated, our results do not change clinical practice but are noteworthy in terms of the cause-effect relationship between AF and PE.

Acute Pulmonary Embolism in a National Danish Cohort: Increasing Incidence and Decreasing Mortality

“…22 PE association with AF is not well described, although the fibrillating right atrium may be a significant source of thrombi. 23 The association between PE and CHF has been substantiated in studies in which prophylactic antithrombotic treatment of these patients significantly reduced the risk of venous thrombosis. 24…”

Pulmonary Thromboembolism after Catheter Ablation of Cardiac Arrhythmias

“…Again, the incidence of clinically inapparent PE after CA seems to be much higher than occurrence of manifest PE. For example, among 71 consecutive patients undergoing CA of AF, asymptomatic PE was demonstrated by routine computed tomography after ablation in 6 patients (8%) (6).…”

“…If the triad is fulfilled, a thrombus can be formed -before, during or after the CA procedure. However, PE usually occurs 8 hours to two weeks after sheath withdrawal (6). The most important patient-related and the procedure-related factors for PE occurrence after ablation are summarized in Figure 1.…”

Right Atrial Thrombosis and Pulmonary Embolism: A Narrative Review

“…41 AF can contribute to PE occurrence and vice versa. [42][43][44][45] However, it is not fully understood whether one of these conditions is a trigger of the other. 46 The absence of a clear understanding is possibly caused by the low quality of PE detection and challenges for the recognition of AF as an independent risk factor of PE besides hypertension, coronary artery disease, and other conditions.…”