Incidence of silent cerebral infarctions after catheter ablation of atrial fibrillation utilizing the second-generation cryoballoon

Nakamura, Tomofumi; Okishige, Kaoru; Kanazawa, Tohru; Yamashita, M; Kawaguchi, Naohiko; Kato, Nobutaka; Aoyagi, Haruhiko; Yamauchi, Yasuteru; Sasano, Tetsuo; Hirao, Kazuyuki

doi:10.1093/europace/euw191

Cited by 41 publications

(34 citation statements)

References 24 publications

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“…In AXAFA-AFNET 5, MoCA scores were similar in women and men. The number of study patients with acute brain lesions after ablation (∼25%) was in line with previous publications 19 , 20 and without significant differences in women and men. In light of this relatively high percentage of acute brains lesions, the observation that in both women and men the presence of at least mild cognitive dysfunction according to the MocA test decreased in a similar manner from 32% and 30%, respectively to 23% at the end of follow-up is reassuring but may be related to repetitive testing.…”

Section: Discussionsupporting

confidence: 91%

Sex differences in catheter ablation of atrial fibrillation: results from AXAFA-AFNET 5

et al. 2020

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Abstract Aims Study sex-differences in efficacy and safety of atrial fibrillation (AF) ablation. Methods and results We assessed first AF ablation outcomes on continuous anticoagulation in 633 patients [209 (33%) women and 424 (67%) men] in a pre-specified subgroup analysis of the AXAFA-AFNET 5 trial. We compared the primary outcome (death, stroke or transient ischaemic attack, or major bleeding) and secondary outcomes [change in quality of life (QoL) and cognitive function] 3 months after ablation. Women were older (66 vs. 63 years, P < 0.001), more often symptomatic, had lower QoL and a longer history of AF. No sex differences in ablation procedure were found. Women stayed in hospital longer than men (2.1 ± 2.3 vs. 1.6 ± 1.3 days, P = 0.004). The primary outcome occurred in 19 (9.1%) women and 26 (6.1%) men, P = 0.19. Women experienced more bleeding events requiring medical attention (5.7% vs. 2.1%, P = 0.03), while rates of tamponade (1.0% vs. 1.2%) or intracranial haemorrhage (0.5% vs. 0%) did not differ. Improvement in QoL after ablation was similar between the sexes [12-item Short Form Health Survey (SF-12) physical 5.1% and 5.9%, P = 0.26; and SF-12 mental 3.7% and 1.6%, P = 0.17]. At baseline, mild cognitive impairment according to the Montreal Cognitive Assessment (MoCA) was present in 65 (32%) women and 123 (30%) men and declined to 23% for both sexes at end of follow-up. Conclusion Women and men experience similar improvement in QoL and MoCA score after AF ablation on continuous anticoagulation. Longer hospital stay, a trend towards more nuisance bleeds, and a lower overall QoL in women were the main differences observed.

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Section: Discussionsupporting

confidence: 91%

Sex differences in catheter ablation of atrial fibrillation: results from AXAFA-AFNET 5

et al. 2020

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“…The incidence of SCILs in the CBA and HBA groups was 21.5% and 13.8%, respectively, and that in the CBA group was similar to that reported in recent studies with a CB‐based AF ablation . To the best of our knowledge, there have been no previous studies reporting the incidence of silent cerebral embolisms after radiofrequency HBA of AF.…”

Section: Discussionsupporting

confidence: 87%

“…Balloon‐based AF ablation, as well as radiofrequency catheter‐based AF ablation, has a potential risk for periprocedural embolic complications. Symptomatic embolisms, including ischemic strokes, transient ischemic attacks (TIAs), and systemic emboli, after cryoballoon ablation (CBA) of AF are rare occurrences, while silent cerebral emboli detected by brain magnetic resonance (MR) imaging are relatively common, and have been reported to be observed in 4.3% to 50% of patients undergoing CBA . So far, limited data are available on the incidence of symptomatic and silent embolisms after radiofrequency HotBalloon ablation (HBA) of AF …”

Section: Introductionmentioning

confidence: 99%

“…Adequate periprocedural anticoagulation using oral anticoagulants plays an important role in preventing thromboembolic complications associated with AF ablation . The majority of the previous studies with brain MR imaging after CBA consisted of patients receiving periprocedural oral anticoagulation with warfarin, while a few studies included some patients with direct oral anticoagulants (DOACs) in addition to those with warfarin.…”

Section: Introductionmentioning

confidence: 99%

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Postablation cerebral embolisms in balloon‐based atrial fibrillation ablation with periprocedural direct oral anticoagulants: A comparison between cryoballoon and HotBalloon ablation

Nakamura

Sasaki

Take

et al. 2018

Cardiovasc electrophysiol

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Introduction: This prospective observational study aimed to investigate the incidence of symptomatic and silent cerebral embolisms after balloon-based ablation of atrial fibrillation (AF) in patients receiving periprocedural anticoagulation with direct oral anticoagulants (DOACs), and compare that between cryoballoon and HotBalloon ablation (CBA and HBA). Methods and Results:We enrolled 123 consecutive AF patients who underwent a balloon-based pulmonary vein isolation (PVI) and brain magnetic resonance (MR) imaging after the ablation procedure (CBA, n = 65; HBA, n = 58). The DOACs were continued in 62 patients throughout the periprocedural period and discontinued in 61 on the procedural day. Intravenous heparin was infused to maintain an activated clotting time of 300 to 400 seconds during the procedure. No symptomatic embolisms occurred in this series. Silent cerebral ischemic lesions (SCILs) were observed on MR imaging in 22 patients (17.9%), and the incidence of SCILs did not significantly differ between the CBA and HBA groups (21.5 vs 13.8%; P = 0.263).According to a multivariate logistic regression analysis, an older age was an independent positive predictor of SCILs (odds ratio, 1.062; 95% CI, 1.001-1.126; P = 0.046), but neither the balloon catheter type nor periprocedural continuation or discontinuation of the DOACs were significant predictors. The incidence of major and minor bleeding complications was comparable between the CBA and HBA groups (1.5 vs 0%, P = 0.528; 7.7 vs 5.2%, P = 0.424).Conclusions: Both CBA and HBA of AF revealed a similar incidence of postablation cerebral embolisms. Elderly patients may be at a risk of SCILs after a balloon-based PVI with periprocedural DOAC treatment. K E Y W O R D S atrial fibrillation, catheter ablation, cryoballoon, direct oral anticoagulant, embolism, HotBalloon J Cardiovasc Electrophysiol. 2019;30:39-46.wileyonlinelibrary.com/journal/jce

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“…2,7,33 Increased incidence of SCE has been reported with reinsertion and application of a previously withdrawn cryoballoon, multielectrode catheter use for additional left atrial mapping, and transient coronary air embolism. 34 Additional radiofrequency ablation within the left atrium in patients undergoing nonpulmonary vein isolation ablation was an independent risk factor for cerebral ischemic events in a study by Nakamura et al 35 In a very recent metaanalysis published, uninterrupted DOAC was found to of similar bleeding events with comparison to minimally interrupted DOAC and also mirrored our ndings of lesser SCE. 36 However, this study did not explore the procedural aspects, specially relation to use of Heparin and ACT.…”

Section: Predictors Of Silent Cerebral Eventssupporting

confidence: 73%

Outcomes of Uninterrupted vs Interrupted Periprocedural Direct Oral Anticoagulants in Atrial Fibrillation Ablation: A Meta-Analysis

Basu‐Ray

Khanra

Kupó

et al. 2020

Preprint

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BACKGROUND: Studies indicate that uninterrupted anticoagulation is superior to interrupted anticoagulation in the periprocedural period during catheter ablation of atrial fibrillation and has better thromboembolic and hemorrhagic outcomes. Conversely, the few studies addressing the safety and efficacy of interrupted direct oral anticoagulant regimens during catheter ablation of atrial fibrillation are limited by small samples, short follow-up periods, rare events, and variable outcomes. The purpose of this meta-analysis was to compare interrupted and uninterrupted direct oral anticoagulation during catheter ablation of atrial fibrillation.METHODS: A systematic search into PubMed, EMBASE, and the Cochrane databases were performed and five studies were selected that directly that directly compared interrupted versus uninterrupted anticoagulation before ablation and reported procedural outcomes and embolic and bleeding events. The primary outcome of the study was major adverse cerebrocardiovascular events which was a composite of stroke/ transient ischemic attacks and major bleedings, total bleeding which was a composite of major and minor bleedings and silent cerebral events.RESULTS The meta-analysis included 840 patients with uninterrupted anticoagulation and 938 patients with interrupted anticoagulation. Median follow-up was 30 days. Baseline parameters were similar between groups. Activated clotting time before first heparin bolus was significantly longer with uninterrupted anticoagulation (P=.006), whereas mean activated clotting time was similar between the 2 groups (P=.19). Total heparin dose needed was significantly higher with interrupted anticoagulation (mean, ‒1.61; 95% CI, ‒2.67 to ‒0.55; P=.003). Mean procedure time did not vary between groups (P=.81). Overall complication rates were low, with similar major adverse cerebrocardiovascular event (P=.40) and total bleeding (P=.55) rates between groups. Silent cerebral events were significantly more frequent with interrupted anticoagulation (log odds ratio, ‒0.90; 95% CI, ‒1.59 to ‒0.22; P<.01; I2, 33%). Rates of major bleeding, minor bleeding, pericardial effusion, cardiac tamponade, and puncture complications were similar between groups.CONCLUSIONS Uninterrupted anticoagulation during atrial fibrillation ablation has similar bleeding event rates, procedural times, and mean activated clotting times as interrupted anticoagulation, with fewer silent cerebral events.

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Incidence of silent cerebral infarctions after catheter ablation of atrial fibrillation utilizing the second-generation cryoballoon

Cited by 41 publications

References 24 publications

Sex differences in catheter ablation of atrial fibrillation: results from AXAFA-AFNET 5

Sex differences in catheter ablation of atrial fibrillation: results from AXAFA-AFNET 5

Postablation cerebral embolisms in balloon‐based atrial fibrillation ablation with periprocedural direct oral anticoagulants: A comparison between cryoballoon and HotBalloon ablation

Outcomes of Uninterrupted vs Interrupted Periprocedural Direct Oral Anticoagulants in Atrial Fibrillation Ablation: A Meta-Analysis

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