Cerebrovascular Complications Related to Atrial Fibrillation Ablation and Strategies for Periprocedural Stroke Prevention

Csanádi, Zoltán; Nagy‐Baló, Edina; Danik, Stephan; Barrett, Conor D.; Burkhardt, J. David; Sánchez, Javier; Santoro, Francesco; Biase, Luigi Di

doi:10.1016/j.ccep.2013.10.003

Cited by 7 publications

(4 citation statements)

References 72 publications

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“…Pulmonary vein isolation (PVI) is an established therapy for the management of atrial fibrillation (AF) with a low risk of a major complication, including thromboembolism [1][2][3]. Available data indicate that the risk of a clinical or a silent thromboembolic event is related to the periprocedural anticoagulation routine and the ablation technology used [4][5][6][7]. e interaction between coagulation activation and the different maneuvers and techniques used during an AF ablation procedure is not fully understood.…”

Section: Introductionmentioning

confidence: 99%

Intracardiac Fibrinolysis and Endothelium Activation Related to Atrial Fibrillation Ablation with Different Techniques

Hajas

Bagoly

Tóth

et al. 2020

Cardiology Research and Practice

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Objective. The effect of pulmonary vein isolation (PVI) on fibrinolytic and endothelial activation with currently applied periprocedural anticoagulation has not been explored. We measured markers of fibrinolysis and endothelium activation before and after PVI with the second-generation cryoballoon (Cryo), pulmonary vein ablation catheter (PVAC-Gold), and irrigated radiofrequency (IRF). Methods. Markers of fibrinolysis and endothelium activation in left atrial (LA) blood samples were measured in 31 patients before and after PVI (Cryo:10, PVAC-Gold: 7, IRF: 14). Periprocedural anticoagulation included uninterrupted vitamin K antagonist and iv heparin (ACT≥300 sec) during LA dwelling. Results. Levels of D-dimer (median; interquartile range, mgFEU/L) increased with all techniques (PVAC: 0.34; 0.24–0.50 versus 0.70; 0.61–1.31; p=0.0313, Cryo: 0.33; 0.28–0.49 versus 0.79; 0.65–0.93; p=0.0078; IRF 0.33; 0.21–0.44 versus 0.83; 0.56–1.21; p=0.0001). PAP complex level (ng/ml) increased after Cryo (247.3, 199.9–331.6 versus 270.9, 227.9–346.7; p=0.0020) and IRF (265.3; 202.0–800.1 versus 325.6, 250.2–701.9; p=0.0166), but not after PVAC (p=0.2969). PAI-1 activity (%) decreased with the PVAC (1.931; 0.508–3.859 versus 0.735, 0.240–2.707; p=0.0313) and Cryo (0.361; 0.080–1.575 versus 0.378; 0.111–0.915; p=0.0313). A similar trend was observed with IRF (p=0.0676). Both VWF antigen levels and FVIII activity increased after PVI with all the 3 techniques. The levels of soluble VCAM-1 (ng/ml) did not change after PVAC procedures, but increased after Cryo (542, 6; 428.5–753.1 versus 619.2; 499.8–799.0; p=0.0005) and IRF (679.3; 505.0–744.7 versus 770.9; 631.9–894.0; p<0.0001). Conclusion. PVI with contemporary ablation techniques and periprocedural antithrombotic treatment induces coagulation and endothelium activation of similar magnitude with different ablation methods.

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Section: Introductionmentioning

confidence: 99%

Intracardiac Fibrinolysis and Endothelium Activation Related to Atrial Fibrillation Ablation with Different Techniques

Hajas

Bagoly

Tóth

et al. 2020

Cardiology Research and Practice

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“…The concern that these lesions might be related to cognitive decline is supported by limited data [22,23]. It has also been suggested that these lesions might be viewed as surrogates for the clinical stroke risk and are useful for an assessment of the risk involved with different ablation techniques and procedural changes [24]. The present data does suggest that TCD detection during LA ablation might improve our understanding of the micro-embolization process during these procedures.…”

Section: Discussionmentioning

confidence: 68%

Cerebral micro-embolization during pulmonary vein isolation: Relation to post-ablation silent cerebral ischemia

et al. 2017

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“…The risk of a potentially life-threatening bleeding complication inherent to transseptal catheterization, catheter manipulation, and the delivery of ablative energy in the thin-wall LA argue against uninterrupted administration of any OAC in the absence of a specific antidote capable of restoring hemostasis in case of a bleeding complication. Despite these concerns, observational and randomized clinical trials have demonstrated the safety or even superiority of uninterrupted administration of vitamin K antagonists (VKA) [9][10][11]. Recently, different Non-Vitamin-K Oral Anticoagulants (NOACs) have also been studied in this clinical scenario.…”

Section: Introductionmentioning

confidence: 99%

Uninterrupted Dabigatran Administration Provides Greater Inhibition against Intracardiac Activation of Hemostasis as Compared to Vitamin K Antagonists during Cryoballoon Catheter Ablation of Atrial Fibrillation

Bagoly

Hajas

Urbancsek

et al. 2020

JCM

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Background. Cerebral thromboembolism is a rare but feared complication of transcatheter ablation in patients with atrial fibrillation (AF). Here, we aimed to test which pre-procedural anticoagulation strategy results in less intracardiac activation of hemostasis during ablation. Patients and methods. In this observational study, 54 paroxysmal/persistent AF patients undergoing cryoballoon ablation were grouped according to their periprocedural anticoagulation strategy: no anticoagulation (oral anticoagulation (OAC) free; n = 24), uninterrupted vitamin K antagonists (VKA) (n = 11), uninterrupted dabigatran (n = 17). Blood was drawn from the left atrium before and immediately after the ablation procedure. Cryoablations were performed according to standard protocols, during which heparin was administered. Heparin-insensitive markers of hemostasis and endothelial damage were tested from intracardiac samples: D-dimer, quantitative fibrin monomer (FM), plasmin-antiplasmin complex (PAP), von Willebrand factor (VWF) antigen, chromogenic factor VIII (FVIII) activity. Results. D-dimer increased significantly in all groups post-ablation, with lowest levels in the dabigatran group (median [interquartile range]: 0.27 [0.36] vs. 1.09 [1.30] and 0.74 [0.26] mg/L in OAC free and uninterrupted VKA groups, respectively, p < 0.001). PAP levels were parallel to this observation. Post-ablation FM levels were elevated in OAC free (26.34 [30.04] mg/L) and VKA groups (10.12 [16.01] mg/L), but remained below cut-off in all patients on dabigatran (3.98 [2.0] mg/L; p < 0.001). VWF antigen and FVIII activity increased similarly post-ablation in all groups, suggesting comparable procedure-related endothelial damage. Conclusion. Dabigatran provides greater inhibition against intracardiac activation of hemostasis as compared to VKAs during cryoballoon catheter ablation.

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Cerebrovascular Complications Related to Atrial Fibrillation Ablation and Strategies for Periprocedural Stroke Prevention

Cited by 7 publications

References 72 publications

Intracardiac Fibrinolysis and Endothelium Activation Related to Atrial Fibrillation Ablation with Different Techniques

Intracardiac Fibrinolysis and Endothelium Activation Related to Atrial Fibrillation Ablation with Different Techniques

Cerebral micro-embolization during pulmonary vein isolation: Relation to post-ablation silent cerebral ischemia

Uninterrupted Dabigatran Administration Provides Greater Inhibition against Intracardiac Activation of Hemostasis as Compared to Vitamin K Antagonists during Cryoballoon Catheter Ablation of Atrial Fibrillation

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