Abstract 23233: Asymptomatic Cerebral Infarction During Catheter Ablation Of Atrial Fibrillation Comparing Uninterrupted Rivaroxaban And Warfarin (ASCERTAIN Study)
Introduction: The incidence of asymptomatic cerebral infarctions (ACIs) during catheter ablation (CA) of atrial fibrillation (AF) is reported to be 10-30%, which could be affected by periprocedural oral anticoagulation. We conducted a randomized study to evaluate the prophylaxis against CA-induced ACIs for uninterrupted rivaroxaban versus warfarin and to identify the risk factors.
Methods: A total of 132 patients with non-valvular atrial fibrillation undergoing radiofrequency CA of AF were randomly assigned to uninterrupted rivaroxaban or warfarin as a periprocedural anticoagulation administered at least 1 month before the CA. The activated clotting time was maintained over 300sec during the CA. Cerebral magnetic resonance imaging (MRI) was performed within 2 weeks before and 1 day after the CA to detect ACIs. All MRI images were analyzed in a blind manner by 2 diagnostic radiologists independent of the investigators. Five patients were withdrawn and 64 rivaroxaban group and 63 warfarin group patients were included in the analysis.
Results: The demographic characteristics were an age of 58.9±9.6 years old, 106(83.5%) males, 82(64.6%) with paroxysmal AF, 28(22.0%) with persistent AF, 17(13.4%) with longstanding persistent AF, and average number of DCs during CA of 1.8±2.5, and there were no differences between rivaroxaban vs. warfarin. The incidence of CA-induced ACIs was 15.6% (10/64) for rivaroxaban and 15.9% (10/63) for warfarin without significant intergroup differences (p=1.000). No symptomatic hemorrhages or thromboembolic events occurred 1 month before or after the CA, except for in one rivaroxaban group patient that developed a cardiac tamponade during the CA. By a multiple logistic regression analysis, the age (p=0.034, OR=1.108), systolic blood pressure (p=0.011, OR=1.043), and severe deep and subcortical white matter hyperintensity detected by pre-CA MRI (p=0.008, OR=5.975) were identified as risk factors of CA-induced ACIs.
Conclusions: No notable difference was found in the incidence of CA-induced ACIs between uninterrupted rivaroxaban and warfarin. The age, higher systolic blood pressure, and ischemic changes detected by MRI before ablation were suggested as potential risk factors of CA-induced ACIs (UMIN000013341).
Author Disclosures: T. Kimura: None. K. Nakajima: None. S. Kashimura: None. A. Kunitomi: None. Y. Katsumata: None. T. Nishiyama: None. K. Inagawa: None. Y. Ikegami: None. N. Nishiyama: None. Y. Aizawa: None. K. Tanimoto: None. K. Fukuda: None.
- © 2016 by American Heart Association, Inc.