Abstract 13850: Comparison of Procedural Thromboembolism During Catheter Ablation of Atrial Fibrillation between Patients with Paroxysmal and Persistent AF
Purpose: Cerebral thromboembolism has been known as a serious complication related to the catheter ablation of atrial fibrillation (AF). This study was conducted to compare the incidence of procedural thromboembolism between patients with paroxysmal and persistent AF who underwent catheter ablation.
Methods: 204 AF patients (paroxysmal AF: 112 and persistent AF: 92) who underwent catheter ablation by using an open-irrigated ablation catheter were included in the present study. All patients undertook the optimal anticoagulation treatment with warfarin for at least 3 months prior to the procedure. Heparin was continuously administered with a target activated coagulation time of 300-350 seconds, which was monitored every 20 minutes through the ablation procedure. Pulmonary vein was isolated from the left atrium with the guidance of a circular mapping catheter. Supplemental ablation in the left atrium (electrogram based ablation or linear ablations) was performed to modify the substrate in persistent AF patients. Brain diffusion-weighted magnetic resonance imaging (DWI) was performed to evaluate the acute cerebral infarction at the day after ablation procedure in all patients.
Results: No symptomatic thromboembolism was observed in the present series. In total, the DWI revealed the silent thromboembolism in 52 (25.5%) patients. There was no significant difference in the pre-procedural clinical variables between patients with paroxysmal and persistent AF, except the left atrial dimension (37.6±4.9 mm in paroxysmal AF vs. 41.6±6.2 mm in persistent AF, P <0.0001). The procedure time (203±55min vs. 239±47min, P <0.0001) and total duration of radiofrequency application (35±16 min vs. 50±24 min, P <0.0001) was longer in paroxysmal AF compared to persistent AF. The incidence of embolism in patients with paroxysmal AF, however, was similar to that in persistent AF (24.1 % (27/112) vs. 27.2 % (25/92), P = 0.23).
Conclusion: Procedure related silent thromboembolism was observed in a quarter of patients who underwent AF ablation even with an open irrigated ablation catheter. Progression of AF did not have an impact on the incidence of thromboembolism during AF ablation.
- © 2012 by American Heart Association, Inc.