Abstract 15324: Peri-Procedural Anticoagulation Regimen Influences the Clinical Course of Migraine in Atrial Fibrillation Patients With or Without Pre-Existent Migraine
Introduction: Isolated reports on migraine prophylaxis using anti-coagulant warfarin are found in the literature. Effective anticoagulation to reduce the risk of thromboembolism is an important part of management of atrial fibrillation (AF), more so when the patients receive ablative therapy for AF. However, limited data is available on the impact of anticoagulation therapy during the ablation procedure on the trajectory of migraine. Therefore, we evaluated the influence of peri-procedural warfarin regimen on the clinical course of migraine in AF patients with or without migraine history, undergoing catheter ablation.
Methods: Forty patients with (group 1, 64±8 years, male 78%) and 85 (group 2, 61±10 years, male 73%) without migraine history undergoing AF-ablation were enrolled. Migraine status was evaluated using a standardized questionnaire. Diffusion MRI (dMRI) of brain was performed for all at pre- and 24-hour post-procedure.
Results: Catheter ablation was performed either with (88, 70%) or without (37, 30%) continuous warfarin treatment. Fifty-four patients (11 and 43 from group 1 and 2 respectively) had subtherapeutic INR on procedure day. At 17 ± 5 months follow-up, among group 1 population, 25 (63%) reported no migraine, 10 (25%) had <1 and 3 (8%) had 2-3 monthly symptoms. Two patients from group 1 reported increased migraine severity and 2 from group 2 had new-onset migraine. All four having either increased migraine severity or new migraine had subtherapeutic INR on the procedure day and new post-procedure MRI findings such as silent cerebral infarcts. Follow-up dMRI revealed new infarcts in 9.6% (12/125) patients; of which 11 had subtherapeutic preprocedural INR on or off continuous warfarin.
Conclusion: Catheter ablation performed under therapeutic INR was not accompanied with incident migraine or worsening of existing migraine. On the other hand, suboptimal anticoagulation showed association with new migraine, aggravation of pre-existent headache, and post-procedural cerebral infarcts.
Author Disclosures: S. Mohanty: None. P. Mohanty: None. N. Rutledge: None. L. Di Biase: Consultant/Advisory Board; Modest; Biosense Webster, Hansen Medical, St. Jude Medical. C. Trivedi: None. P. Santangeli: None. R. Bai: None. A. Al-Ahmad: None. J.D. Burkhardt: None. J. Gallinghouse: None. R. Horton: None. J. Sanchez: None. S. Bailey: None. P. Hranitzky: None. J. Zagrodzky: None. A. Natale: Honoraria; Modest; Biosense Webster, Janssen, Boston Scientific, Medtronic, St. Jude Medical.
- © 2014 by American Heart Association, Inc.