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Published on: July 20, 2022
Incidence of Migraine Following Pulsed-Field Ablation for Atrial Fibrillation: Findings From a Multicenter Analysis
Sanghamitra Mohanty1, Yaariv Khaykin2, Mouhannad Sadek2
1Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.
Background:
New-onset migraine or exacerbation of pre-existent migraine has been reported following catheter ablation for atrial fibrillation (AF). We assessed the incidence of migraine following pulsed-field ablation (PFA).
Methods:
Consecutive AF patients undergoing PFA using either Farawave or Pulse Select or Sphere 9 catheter systems were included in this multicenter study and prospectively followed up for new migraine or an increase in the severity of the pre-existent headache. Migraine was labeled as "new onset" if the condition was diagnosed for the first time after the index ablation without any previous history, recent or remote. Anti-arrhythmic drugs and oral anticoagulation were prescribed for 2 months after the procedure.
Results:
A total of 2148 AF patients undergoing PFA procedures (Farawave: 1477; Pulse Select: 369; and Sphere 9: 392) at the participating centers were included in the analysis. A history of migraine was present in 32 (1.48%) patients, of which 6(18.75%) reported an increase in frequency of migraine in the immediate post-ablation period. New-onset migraine was diagnosed in 31 (1.4%) post-PFA patients. Of these 31 patients, 25 (80.6%) underwent PFA using the Farapulse system, Sphere 9 in 5 (16.12%), and Pulse Select in 1 (3.22%) patient. The incidence of new-onset migraine was comparable between different systems; 1.69% (95% CI 1.10%-2.49%), 1.65% (95% CI 0.54%-3.82%), and 0.27% (95% CI 0.01%-1.50%) for Farapulse, Sphere 9, and Pulse Select, respectively. Mean duration of onset was 3.08 ± 0.67 days post-procedure. In the multivariable regression analysis, BMI was found to be the only predictor of new-onset migraine (OR = 1.402; 95% CI 1.002-1.987; p-value = 0.031).
Conclusion:
New-onset migraine was observed to be uncommon in patients undergoing PFA. Although the incidence rate was comparable among the three platforms analyzed, the Farawave system showed a higher trend. Of note, BMI was an independent predictor of new migraine.
