Abstract 14304: Left Atrial Scar Does Not Correlate With Hystory of Stroke: Results From a Prospective Study
INTRODUCTION: Atrial fibrillation increases the risk of stroke. Recently DE-MRI detection of left atrial fibrosis has been associated with prior history of strokes.
We sought to determine the association between left atrial (LA) scar and the history of pre and post ablation stroke.
METHODS: Consecutive patients undergoing AF ablation, who had moderate or severe left atrial scar (LAS) by 3D mapping voltage, were evaluated. Their risk factor profiles, including history of previous stroke/TIA, and oral anticoagulation utilization were recorded. Scar was defined as an area with a bipolar voltage amplitude ≤ 0.05 mV. The degree LAS was determined as a percentage of the left atrial area (moderate 20-60%, and severe >60%).
RESULTS: A total of 688 patients, (78% male, 63±11 years, LA size 49±20mm, 63% moderate and 37% severe LAS) were included in this study. History of previous stroke was present in 62 (9%) of the patients. Left appendage was isolated in 234(34%). History of stroke was not associated with degree of LAS (7.7% and 9.7% in moderate and severe LAS respectively, p=0.39). Further, the prevalence of higher CHADS(2) score was not different between moderate and severe LAS cohorts [42% and 46% had CHADS(2) ≥2 respectively (p=0.36)]. A total of 6 (0.9%) strokes were observed during the 28±8 month’s follow-up. After adjusting for important clinical risk factors in a multivariable logistic model, post ablation warfarin discontinuation in patients with LAA isolation resulted an independent predictor of post procedure stroke (odds ratio 2.71, 95% CI 1.48-4.77, p<0.01) while severe LAS did not show significant association (OR 1.2, 95% CI 0.87-1.66, p=0.27).
CONCLUSIONS: Left atrial scar as detected by 3D mapping does not correlate with the history of strokes and does not predict stroke following AF ablation.
- © 2013 by American Heart Association, Inc.