Key result
Silent cerebral events occurred in 23.1% of patients undergoing AF ablation on uninterrupted anticoagulation; older age, larger left atrial dimension, and ACT kinetics were significant predictors.
Why the study?
Although uninterrupted oral anticoagulation reduces silent cerebral events during AF ablation, their incidence persists.
What are the clinical and procedural predictors of silent cerebral events during atrial fibrillation ablation in patients on uninterrupted oral anticoagulation?
Observational (n=285)
What are the clinical and procedural predictors of silent cerebral events during atrial fibrillation ablation in patients on uninterrupted oral anticoagulation?
Age, left atrial dimension, and intraprocedural ACT kinetics (lower baseline ACT and longer time to optimal ACT) are significant predictors of silent cerebral events during AF ablation on uninterrupted anticoagulation.
SCEs persist at 23% despite uninterrupted OAC during AF ablation; leaves open optimization of periprocedural factors in prospective studies.
Introduction Silent cerebral events (SCEs) are related to the potential thromboembolic risk in atrial fibrillation (AF) ablation. Periprocedural uninterrupted oral anticoagulation (OAC) reportedly reduced the risk of SCEs, but the incidence still remains. Methods and Results AF patients undergoing catheter ablation were eligible. All patients took non–vitamin K antagonist oral anticoagulants (NOACs; n = 248) or vitamin K antagonist (VKA; n = 37) for periprocedural OAC (>4 weeks) without interruption during the procedure. Brain magnetic resonance imaging was performed within 2 days after the procedure to detect SCEs. Clinical characteristics and procedure‐related parameters were compared between patients with and without SCEs. SCEs were detected in 66 patients (23.1%; SCE[+]) but were not detected in 219 patients (SCE[−]). Age was higher in SCE[+] than in SCE[−] (66 ± 10 vs. 62 ± 12 years; p < .05). Persistent AF prevalence, CHADS 2 /CHA 2 DS 2 ‐VASc scores, serum NT‐ProBNP levels, left atrial dimension (LAD), and spontaneous echo contrast prevalence in transesophageal echocardiography significantly increased in SCE[+] versus SCE[−]. SCE[+] had lower baseline activated clotting time (ACT) before heparin injection and longer time to reach optimal ACT (>300 s) than SCE[−] (146 ± 27 vs. 156 ± 29 s and 44 ± 30 vs. 35 ± 25 min; p < .05, respectively). In multivariate analysis, age, LAD, baseline ACT, and time to reach the optimal ACT were predictors for SCEs. The average values of the ACT parameters were significantly different among NOACs/VKA. Conclusion Age, LAD, and intraprocedural ACT kinetics significantly affect SCEs during AF ablation. Different anticoagulants have different impacts on ACT during the procedure, which should be considered when estimating the risk of SCEs.
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Harada et al. (2020) conducted an observational in Atrial fibrillation (n=285). Risk factors (older age, larger left atrial dimension, ACT kinetics) vs. Absence of risk factors was evaluated on Silent cerebral events (SCEs) detected by brain MRI within 2 days after the procedure. Silent cerebral events occurred in 23.1% of patients undergoing AF ablation on uninterrupted anticoagulation; older age, larger left atrial dimension, and ACT kinetics were significant predictors.
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