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Late-phase thromboembolism after catheter ablation for paroxysmal atrial fibrillation
Masateru Takigawa1, Atsushi Takahashi, Taishi Kuwahara
1Cardiovascular Center, Yokosuka Kyosai Hospital.
Insights
Late-phase thromboembolism (TE) after catheter ablation (CA) for atrial fibrillation (AF) is rare. A CHADS2 score of 2 or higher independently predicts an increased risk of late-phase TE in patients undergoing CA for AF.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Catheter ablation (CA) is a common treatment for paroxysmal atrial fibrillation (AF).
- Late-phase thromboembolism (TE) is a potential complication after CA, but its incidence and predictors require further elucidation.
Purpose of the Study:
- To investigate the incidence of late-phase thromboembolism (TE) following catheter ablation (CA) for paroxysmal atrial fibrillation (AF).
- To identify predictors of late-phase TE after CA for paroxysmal AF.
Main Methods:
- A cohort of 1,156 patients undergoing CA for symptomatic paroxysmal AF was studied.
- Follow-up duration averaged 49.5 months to assess late-phase TE events.
- Kaplan-Meier analysis and multivariate analysis were used to identify risk factors.
Main Results:
- Nine patients (0.78%) developed late-phase TE, all presenting as ischemic stroke.
- Factors associated with increased TE risk included structural heart disease, AF recurrence, prior stroke, CHADS2 score ≥2, reduced left ventricular ejection fraction, and spontaneous echo contrast.
- A CHADS2 score ≥2 independently predicted late-phase TE (HR, 4.49; P=0.04).
Conclusions:
- The incidence of late-phase TE after CA for paroxysmal AF is low.
- A CHADS2 score of 2 or greater is an independent predictor of late-phase TE.
- Risk stratification using CHADS2 score is crucial for managing patients post-CA for AF.
Background:
The aim of this study was to investigate the incidence and predictors (which have not previously been fully elucidated) of late-phase thromboembolism (TE) after catheter ablation (CA) for paroxysmal atrial fibrillation (AF).
Methods And Results:
We studied 1,156 consecutive patients (61±10 years; 891 men; CHADS2score, 0.8±1.0) after CA for symptomatic paroxysmal AF and examined the details of late-phase TE. During a follow-up of 49.5±21.9 months (median, 47 months; range, 6-113 months) after CA, 9 patients (0.78%) developed late-phase TE, all of which were ischemic stroke. Of these, 5 patients with AF recurrence experienced cardioembolism; the AF was asymptomatic at recurrence. The remaining 4 without AF recurrence experienced cardioembolism (n=1), small-vessel occlusion (n=1), large-artery atherosclerosis (n=1), and stroke of other determined etiology (n=1). On Kaplan-Meier analysis patients with structural heart disease (P=0.003), AF recurrence after the final CA (P=0.01), prior stroke (P=0.002), CHADS2score ≥2 (P=0.0002), left ventricular ejection fraction <50% (P<0.0001), and spontaneous echo contrast on transesophageal echocardiogram (P=0.0004) had a significantly higher risk of late-phase TE. Multivariate analysis indicated that CHADS2score ≥2 (HR, 4.49; 95% CI: 1.08-22.56; P=0.04) independently predicted late-phase TE.
Conclusions:
The incidence of TE was low after CA for paroxysmal AF, but CHADS2score ≥2 independently increased the risk of late-phase TE.
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