Key result
Silent cerebral events occur in ~23% of AF ablations, predicted by LA size and ACT.
Why the study?
Silent cerebral events remain a risk during atrial fibrillation ablation despite peri-procedural uninterrupted oral anticoagulation, and factors associated with SCEs need clarification.
Cohort (n=285)
Left-atrial dimension and intra-procedural ACT kinetics are significant predictors of silent cerebral events during AF ablation in patients on uninterrupted oral anticoagulation.
SCEs persist despite uninterrupted peri-procedural OAC in AF ablation; leaves open optimal regimen and need for randomized confirmation.
Introduction: Silent cerebral events (SCEs) are related to the potential thromboembolic risk in atrial fibrillation (AF) ablation. Peri-procedural 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 peri-procedural 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[-]). Average age was higher in SCE[+] than in SCE[-] (66±10 years vs. 62±12 years, p<0.05). Persistent AF prevalence, CHADS2/CHA2DS2-VASc scores, serum NT-ProBNP levels, left-atrial dimension (LAD), and spontaneous echo contrast prevalence in transesophageal echocardiography significantly increased in SCE[+] vs. SCE[-]. SCE[+] had lower baseline activated clotting time (ACT) before heparin injection and longer time to reach optimal ACT (>300 sec) than SCE [-] (146±27 sec vs. 156±29 sec and 44±30 sec vs. 35±25 sec, p<0.05, respectively). In multivariate analysis, 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: LAD and intra-procedural 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 a cohort in Atrial fibrillation (n=285). Catheter ablation on uninterrupted oral anticoagulation was evaluated on Silent cerebral events (SCEs) detected by brain MRI. Among AF patients undergoing catheter ablation on uninterrupted oral anticoagulation, silent cerebral events occurred in 23.1% and were significantly predicted by left-atrial dimension and ACT kinetics.
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