Abstract 2546: Periprocedural Stroke in Patients Undergoing Catheter Ablation of Atrial Fibrillation: The Impact of Periprocedural Thereapeutic INR
Background: Catheter ablation of atrial fibrillation is associated with a potential periprocedural risk of stroke in a range varying from 1 to 5 %. We evaluated the rate of stroke over time to assess whether the periprocedural anticoagulation strategy and the use of open irrigation ablation catheter have resulted in a reduction of the prevalence of this complication.
Methods: We collected data from six centers performing the same ablation procedure with the same anticoagulation protocol. Based on the ablation catheter utilized and the anticoagulation protocol used at the time of the procedure, we divided all the patients in 3 groups: ablation using an 8 mm catheter off Coumadin (Group I), ablation with an open irrigated catheter off Coumadin (Group II) and ablation with an open irrigated catheter on Coumadin (Group III). Outcome data on stroke and TIA during the procedures were collected.
Results: 5954 PVAI procedures were identified. Of these procedures, 2488 were in Group I, 1348 in group II and 2118 in group III. There were 19 cardio-embolic stroke in Group I (0.7%), 7 (0.5%) in group II, and 0% in group III. When considering TIA the event rate were 1.1% for group I, 0.9 for group II and 0% for group III. Group III did not experience stoke/Tia despite a higher prevalence of non paroxysmal AF and a higher number of patients with CHADS2 score >2.(table⇓).
Conclusions: Our results suggest that the combination of an open irrigation ablation catheter with peri-procedural therapeutic anticoagulation with Coumadin can reduce the risk of peri-procedural stroke.