Periprocedural Stroke and Management of Major Bleeding Complications in Patients Undergoing Catheter Ablation of Atrial Fibrillation: The Impact of Periprocedural Therapeutic International Normalized Ratio
Catheter ablation of atrial fibrillation is associated with the potential risk of periprocedural stroke, which can range between 1% and 5%. We developed a prospective database to evaluate the prevalence of stroke over time and to assess whether the periprocedural anticoagulation strategy and use of...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2010-06, Vol.121 (23), p.2550-2556 |
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| creator | DI BIASE, Luigi BURKHARDT, J. David HAO, Steven BEHEIRY, Salwa PELARGONIO, Gemma DELLO RUSSO, Antonio CASELLA, Michela SANTARELLI, Pietro SANTANGELI, Pasquale WANG, Paul AL-AHMAD, Amin PATEL, Dimpi MOHANTY, Prasant THEMISTOCLAKIS, Sakis BONSO, Aldo ROSSILLO, Antonio CORRADO, Andrea RAVIELE, Antonio CUMMINGS, Jennifer E SCHWEIKERT, Robert A LEWIS, William R NATALE, Andrea SANCHEZ, Javier HORTON, Rodney GALLINGHOUSE, G. Joseph LAKKIREDDY, Dhanunjay VERMA, Atul KHAYKIN, Yaariv HONGO, Richard |
| description | Catheter ablation of atrial fibrillation is associated with the potential risk of periprocedural stroke, which can range between 1% and 5%. We developed a prospective database to evaluate the prevalence of stroke over time and to assess whether the periprocedural anticoagulation strategy and use of open irrigation ablation catheter have resulted in a reduction of this complication.
We collected data from 9 centers performing the same ablation procedure with the same anticoagulation protocol. We divided the patients into 3 groups: ablation with an 8-mm catheter off warfarin (group 1), ablation with an open irrigated catheter off warfarin (group 2), and ablation with an open irrigated catheter on warfarin (group 3). Outcome data on stroke/transient ischemic attack and bleeding complications during and early after the procedures were collected. Of 6454 consecutive patients in the study, 2488 were in group 1, 1348 were in group 2, and 2618 were in group 3. Periprocedural stroke/transient ischemic attack occurred in 27 patients (1.1%) in group 1 and 12 patients (0.9%) in group 2. Despite a higher prevalence of nonparoxysmal atrial fibrillation and more patients with CHADS2 (congestive heart failure, hypertension, age >75 years, diabetes mellitus, and prior stroke or transient ischemic attack) score >2, no stroke/transient ischemic attack was reported in group 3. Complications among groups 1, 2, and 3, including major bleeding (10 [0.4%], 11 [0.8%], and 10 [0.4%], respectively; P>0.05) and pericardial effusion (11 [0.4%], 11 [0.8%], and 12 [0.5%]; P>0.05), were equally distributed.
The combination of an open irrigation ablation catheter and periprocedural therapeutic anticoagulation with warfarin may reduce the risk of periprocedural stroke without increasing the risk of pericardial effusion or other bleeding complications. |
| doi_str_mv | 10.1161/CIRCULATIONAHA.109.921320 |
| format | Article |
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We collected data from 9 centers performing the same ablation procedure with the same anticoagulation protocol. We divided the patients into 3 groups: ablation with an 8-mm catheter off warfarin (group 1), ablation with an open irrigated catheter off warfarin (group 2), and ablation with an open irrigated catheter on warfarin (group 3). Outcome data on stroke/transient ischemic attack and bleeding complications during and early after the procedures were collected. Of 6454 consecutive patients in the study, 2488 were in group 1, 1348 were in group 2, and 2618 were in group 3. Periprocedural stroke/transient ischemic attack occurred in 27 patients (1.1%) in group 1 and 12 patients (0.9%) in group 2. Despite a higher prevalence of nonparoxysmal atrial fibrillation and more patients with CHADS2 (congestive heart failure, hypertension, age >75 years, diabetes mellitus, and prior stroke or transient ischemic attack) score >2, no stroke/transient ischemic attack was reported in group 3. Complications among groups 1, 2, and 3, including major bleeding (10 [0.4%], 11 [0.8%], and 10 [0.4%], respectively; P>0.05) and pericardial effusion (11 [0.4%], 11 [0.8%], and 12 [0.5%]; P>0.05), were equally distributed.
The combination of an open irrigation ablation catheter and periprocedural therapeutic anticoagulation with warfarin may reduce the risk of periprocedural stroke without increasing the risk of pericardial effusion or other bleeding complications.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.109.921320</identifier><identifier>PMID: 20516376</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Aged ; Anticoagulants - therapeutic use ; Atrial Fibrillation - blood ; Atrial Fibrillation - therapy ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood Loss, Surgical - prevention & control ; Cardiac Catheterization - adverse effects ; Cardiology. Vascular system ; Catheter Ablation - adverse effects ; Disease Management ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Female ; Follow-Up Studies ; Hemorrhage - blood ; Hemorrhage - etiology ; Hemorrhage - prevention & control ; Humans ; International Normalized Ratio ; Intraoperative Complications - blood ; Intraoperative Complications - etiology ; Intraoperative Complications - prevention & control ; Male ; Medical sciences ; Middle Aged ; Neurology ; Perioperative Care - adverse effects ; Prospective Studies ; Stroke - blood ; Stroke - etiology ; Stroke - prevention & control ; Vascular diseases and vascular malformations of the nervous system</subject><ispartof>Circulation (New York, N.Y.), 2010-06, Vol.121 (23), p.2550-2556</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c205t-effa10ce8486cf3bf50629787d035c628df89ba202fb59bbe4f418a2fbeec59b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22914061$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20516376$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>DI BIASE, Luigi</creatorcontrib><creatorcontrib>BURKHARDT, J. David</creatorcontrib><creatorcontrib>HAO, Steven</creatorcontrib><creatorcontrib>BEHEIRY, Salwa</creatorcontrib><creatorcontrib>PELARGONIO, Gemma</creatorcontrib><creatorcontrib>DELLO RUSSO, Antonio</creatorcontrib><creatorcontrib>CASELLA, Michela</creatorcontrib><creatorcontrib>SANTARELLI, Pietro</creatorcontrib><creatorcontrib>SANTANGELI, Pasquale</creatorcontrib><creatorcontrib>WANG, Paul</creatorcontrib><creatorcontrib>AL-AHMAD, Amin</creatorcontrib><creatorcontrib>PATEL, Dimpi</creatorcontrib><creatorcontrib>MOHANTY, Prasant</creatorcontrib><creatorcontrib>THEMISTOCLAKIS, Sakis</creatorcontrib><creatorcontrib>BONSO, Aldo</creatorcontrib><creatorcontrib>ROSSILLO, Antonio</creatorcontrib><creatorcontrib>CORRADO, Andrea</creatorcontrib><creatorcontrib>RAVIELE, Antonio</creatorcontrib><creatorcontrib>CUMMINGS, Jennifer E</creatorcontrib><creatorcontrib>SCHWEIKERT, Robert A</creatorcontrib><creatorcontrib>LEWIS, William R</creatorcontrib><creatorcontrib>NATALE, Andrea</creatorcontrib><creatorcontrib>SANCHEZ, Javier</creatorcontrib><creatorcontrib>HORTON, Rodney</creatorcontrib><creatorcontrib>GALLINGHOUSE, G. Joseph</creatorcontrib><creatorcontrib>LAKKIREDDY, Dhanunjay</creatorcontrib><creatorcontrib>VERMA, Atul</creatorcontrib><creatorcontrib>KHAYKIN, Yaariv</creatorcontrib><creatorcontrib>HONGO, Richard</creatorcontrib><title>Periprocedural Stroke and Management of Major Bleeding Complications in Patients Undergoing Catheter Ablation of Atrial Fibrillation: The Impact of Periprocedural Therapeutic International Normalized Ratio</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Catheter ablation of atrial fibrillation is associated with the potential risk of periprocedural stroke, which can range between 1% and 5%. We developed a prospective database to evaluate the prevalence of stroke over time and to assess whether the periprocedural anticoagulation strategy and use of open irrigation ablation catheter have resulted in a reduction of this complication.
We collected data from 9 centers performing the same ablation procedure with the same anticoagulation protocol. We divided the patients into 3 groups: ablation with an 8-mm catheter off warfarin (group 1), ablation with an open irrigated catheter off warfarin (group 2), and ablation with an open irrigated catheter on warfarin (group 3). Outcome data on stroke/transient ischemic attack and bleeding complications during and early after the procedures were collected. Of 6454 consecutive patients in the study, 2488 were in group 1, 1348 were in group 2, and 2618 were in group 3. Periprocedural stroke/transient ischemic attack occurred in 27 patients (1.1%) in group 1 and 12 patients (0.9%) in group 2. Despite a higher prevalence of nonparoxysmal atrial fibrillation and more patients with CHADS2 (congestive heart failure, hypertension, age >75 years, diabetes mellitus, and prior stroke or transient ischemic attack) score >2, no stroke/transient ischemic attack was reported in group 3. Complications among groups 1, 2, and 3, including major bleeding (10 [0.4%], 11 [0.8%], and 10 [0.4%], respectively; P>0.05) and pericardial effusion (11 [0.4%], 11 [0.8%], and 12 [0.5%]; P>0.05), were equally distributed.
The combination of an open irrigation ablation catheter and periprocedural therapeutic anticoagulation with warfarin may reduce the risk of periprocedural stroke without increasing the risk of pericardial effusion or other bleeding complications.</description><subject>Aged</subject><subject>Anticoagulants - therapeutic use</subject><subject>Atrial Fibrillation - blood</subject><subject>Atrial Fibrillation - therapy</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Blood Loss, Surgical - prevention & control</subject><subject>Cardiac Catheterization - adverse effects</subject><subject>Cardiology. Vascular system</subject><subject>Catheter Ablation - adverse effects</subject><subject>Disease Management</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hemorrhage - blood</subject><subject>Hemorrhage - etiology</subject><subject>Hemorrhage - prevention & control</subject><subject>Humans</subject><subject>International Normalized Ratio</subject><subject>Intraoperative Complications - blood</subject><subject>Intraoperative Complications - etiology</subject><subject>Intraoperative Complications - prevention & control</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neurology</subject><subject>Perioperative Care - adverse effects</subject><subject>Prospective Studies</subject><subject>Stroke - blood</subject><subject>Stroke - etiology</subject><subject>Stroke - prevention & control</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkctu1DAUhq2Kqp0WXgGZBWKVqe1czS5ElEYa2qrMrCPHOZ66JHZqJwv6jrwTngsg8Mbn8p2bfoTeUbKkNKNXVf1QbVblur67LW_KJSV8yRmNGTlBC5qyJErSmL9CC0IIj_KYsXN04f1TcLM4T8_QOSMpDWa2QD_vwenRWQnd7ESPv03OfgcsTIe_CiO2MICZsFXBe7IOf-oBOm22uLLD2GspJm2Nx9rg-2AG1OON6cBt7R4S0yNM4HDZ9nty16icnA6DrnXrdH8If8TrR8D1MAq5n_XfTiHpxAjzpCWuTehn9lUhc2vdIHr9Ah1-2MVeo1Mleg9vjv8l2lx_Xlc30eruS12Vq0iGy6cIlBKUSCiSIpMqblVKMsbzIu9InMqMFZ0qeCsYYapNedtCohJaiOAByBCIL9GHQ9-w5fMMfmoG7SWEcwzY2Td5HB5PUxpIfiCls947UM3o9CDcj4aSZidm86-YIcybg5ih9u1xytwO0P2p_K1eAN4fAeGl6JUTRmr_l2OcJiSj8S9kmq-G</recordid><startdate>20100615</startdate><enddate>20100615</enddate><creator>DI BIASE, Luigi</creator><creator>BURKHARDT, J. 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David ; HAO, Steven ; BEHEIRY, Salwa ; PELARGONIO, Gemma ; DELLO RUSSO, Antonio ; CASELLA, Michela ; SANTARELLI, Pietro ; SANTANGELI, Pasquale ; WANG, Paul ; AL-AHMAD, Amin ; PATEL, Dimpi ; MOHANTY, Prasant ; THEMISTOCLAKIS, Sakis ; BONSO, Aldo ; ROSSILLO, Antonio ; CORRADO, Andrea ; RAVIELE, Antonio ; CUMMINGS, Jennifer E ; SCHWEIKERT, Robert A ; LEWIS, William R ; NATALE, Andrea ; SANCHEZ, Javier ; HORTON, Rodney ; GALLINGHOUSE, G. 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David</au><au>HAO, Steven</au><au>BEHEIRY, Salwa</au><au>PELARGONIO, Gemma</au><au>DELLO RUSSO, Antonio</au><au>CASELLA, Michela</au><au>SANTARELLI, Pietro</au><au>SANTANGELI, Pasquale</au><au>WANG, Paul</au><au>AL-AHMAD, Amin</au><au>PATEL, Dimpi</au><au>MOHANTY, Prasant</au><au>THEMISTOCLAKIS, Sakis</au><au>BONSO, Aldo</au><au>ROSSILLO, Antonio</au><au>CORRADO, Andrea</au><au>RAVIELE, Antonio</au><au>CUMMINGS, Jennifer E</au><au>SCHWEIKERT, Robert A</au><au>LEWIS, William R</au><au>NATALE, Andrea</au><au>SANCHEZ, Javier</au><au>HORTON, Rodney</au><au>GALLINGHOUSE, G. Joseph</au><au>LAKKIREDDY, Dhanunjay</au><au>VERMA, Atul</au><au>KHAYKIN, Yaariv</au><au>HONGO, Richard</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Periprocedural Stroke and Management of Major Bleeding Complications in Patients Undergoing Catheter Ablation of Atrial Fibrillation: The Impact of Periprocedural Therapeutic International Normalized Ratio</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2010-06-15</date><risdate>2010</risdate><volume>121</volume><issue>23</issue><spage>2550</spage><epage>2556</epage><pages>2550-2556</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>Catheter ablation of atrial fibrillation is associated with the potential risk of periprocedural stroke, which can range between 1% and 5%. We developed a prospective database to evaluate the prevalence of stroke over time and to assess whether the periprocedural anticoagulation strategy and use of open irrigation ablation catheter have resulted in a reduction of this complication.
We collected data from 9 centers performing the same ablation procedure with the same anticoagulation protocol. We divided the patients into 3 groups: ablation with an 8-mm catheter off warfarin (group 1), ablation with an open irrigated catheter off warfarin (group 2), and ablation with an open irrigated catheter on warfarin (group 3). Outcome data on stroke/transient ischemic attack and bleeding complications during and early after the procedures were collected. Of 6454 consecutive patients in the study, 2488 were in group 1, 1348 were in group 2, and 2618 were in group 3. Periprocedural stroke/transient ischemic attack occurred in 27 patients (1.1%) in group 1 and 12 patients (0.9%) in group 2. Despite a higher prevalence of nonparoxysmal atrial fibrillation and more patients with CHADS2 (congestive heart failure, hypertension, age >75 years, diabetes mellitus, and prior stroke or transient ischemic attack) score >2, no stroke/transient ischemic attack was reported in group 3. Complications among groups 1, 2, and 3, including major bleeding (10 [0.4%], 11 [0.8%], and 10 [0.4%], respectively; P>0.05) and pericardial effusion (11 [0.4%], 11 [0.8%], and 12 [0.5%]; P>0.05), were equally distributed.
The combination of an open irrigation ablation catheter and periprocedural therapeutic anticoagulation with warfarin may reduce the risk of periprocedural stroke without increasing the risk of pericardial effusion or other bleeding complications.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>20516376</pmid><doi>10.1161/CIRCULATIONAHA.109.921320</doi><tpages>7</tpages></addata></record> |
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| identifier | ISSN: 0009-7322 |
| ispartof | Circulation (New York, N.Y.), 2010-06, Vol.121 (23), p.2550-2556 |
| issn | 0009-7322 1524-4539 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_733339551 |
| source | MEDLINE; EZB Electronic Journals Library; American Heart Association; Journals@Ovid Complete |
| subjects | Aged Anticoagulants - therapeutic use Atrial Fibrillation - blood Atrial Fibrillation - therapy Biological and medical sciences Blood and lymphatic vessels Blood Loss, Surgical - prevention & control Cardiac Catheterization - adverse effects Cardiology. Vascular system Catheter Ablation - adverse effects Disease Management Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Female Follow-Up Studies Hemorrhage - blood Hemorrhage - etiology Hemorrhage - prevention & control Humans International Normalized Ratio Intraoperative Complications - blood Intraoperative Complications - etiology Intraoperative Complications - prevention & control Male Medical sciences Middle Aged Neurology Perioperative Care - adverse effects Prospective Studies Stroke - blood Stroke - etiology Stroke - prevention & control Vascular diseases and vascular malformations of the nervous system |
| title | Periprocedural Stroke and Management of Major Bleeding Complications in Patients Undergoing Catheter Ablation of Atrial Fibrillation: The Impact of Periprocedural Therapeutic International Normalized Ratio |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-01T11%3A15%3A09IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Periprocedural%20Stroke%20and%20Management%20of%20Major%20Bleeding%20Complications%20in%20Patients%20Undergoing%20Catheter%20Ablation%20of%20Atrial%20Fibrillation:%20The%20Impact%20of%20Periprocedural%20Therapeutic%20International%20Normalized%20Ratio&rft.jtitle=Circulation%20(New%20York,%20N.Y.)&rft.au=DI%20BIASE,%20Luigi&rft.date=2010-06-15&rft.volume=121&rft.issue=23&rft.spage=2550&rft.epage=2556&rft.pages=2550-2556&rft.issn=0009-7322&rft.eissn=1524-4539&rft.coden=CIRCAZ&rft_id=info:doi/10.1161/CIRCULATIONAHA.109.921320&rft_dat=%3Cproquest_cross%3E733339551%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=733339551&rft_id=info:pmid/20516376&rfr_iscdi=true |