Atrial fibrillation ablation in patients with mobile thrombus on pacemaker leads. Prospective single-centre study...

Mobile thrombus on pacemaker leads is a common phenomenon seen during intracardiac echocardiography in patients undergoing catheter ablation of atrial fibrillation (AF).

The purpose of our study is to assess the safety of RF ablation of atrial fibrillation in patients with mobile thrombus on pacemaker leads.

A total of 33 patients with AF and previously implanted cardiac pacemakers who had undergone radiofrequency pulmonary vein isolation since January 1st, 2015, were studied. All patients were anticoagulated with vitamin K antagonists (VKAs) or novel oral anticoagulants (NOACs), at least three weeks before the procedure. All procedures were guided by intracardiac echocardiography. Patients were divided into two groups: group 1 (15 patients with mobile thrombus on pacemaker leads) and group 2 (18 patients without mobile thrombus on device leads).

The mean age of the pacemaker patients was 66,8 ± 7.7 years. The average thrombus length was 8.0 ± 3.3 mm. There were no differences in preprocedural anticoagulation with VKA or NOAC between groups (13% versus 17% for VKA, p = 1.0). Paroxysmal AF was less prevalent in the thrombus group (40% versus 83%, p = 0.01). There were no complications of AF ablation or arrythmia recurrence procedures in either group during the 30-day postoperative period.

Radiofrequency ablation of AF can be safely performed in patients with mobile thrombus on pacemaker leads. Patients with persistent atrial fibrillation have an increased risk of pacemaker lead thrombus formation.