Cerebrovascular complications related to atrial fibrillation ablation and strategies for periprocedural stroke prevention

Cardiac Electrophysiology Clinics

Volumn 6, Issue 1, 2014, Pages 111-123

  Csanadi, Zoltan ^a   Nagy Baló, Edina ^a   Danik, Stephan ^d   Barrett, Conor ^d   Burkhardt, J David ^e   Sanchez, Javier ^e   Santangeli, Pasquale ^f,g   Santoro, Francesco ^g   Di Biase, Luigi ^e,g,h,i   Natale, Andrea ^b,c,e,i  

^a UNIVERSITY OF DEBRECEN   (Hungary)

^b CASE WESTERN RESERVE UNIVERSITY   (United States)

^c SCRIPPS CLINIC   (United States)

^d ST LUKE S ROOSEVELT HOSPITAL CENTER   (United States)

^e TEXAS CARDIAC ARRHYTHMIA INSTITUTE   (United States)

^f UNIVERSITY OF PENNSYLVANIA   (United States)

^g UNIVERSITY OF FOGGIA   (Italy)

^h ALBERT EINSTEIN COLLEGE OF MEDICINE   (United States)

ⁱ The University of Texas at Austin   (United States)

Author keywords

Atrial fibrillation; Diffusion weighted cerebral magnetic resonance imaging; Silent cerebral ischemia; Stroke; Transcranial Doppler

Indexed keywords

EID: 84895070738     PISSN: 18779182     EISSN: 18779190     Source Type: Journal    
DOI: 10.1016/j.ccep.2013.10.003     Document Type: Review

References (67)

1. Cappato R., Calkins H., Chen S.A., et al. Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation 2005, 111:1100.
2. Cappato R., Calkins H., Chen S.A., et al. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol 2010, 3:32-38.
3. Calkins H., Reynolds M.R., Spector P., et al. Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation: two systematic literature reviews and meta-analyses. Circ Arrhythm Electrophysiol 2009, 2:349-361.
4. Kok L.C., Mangrum J.M., Haines D.E., et al. Cerebrovascular complication associated with pulmonary vein ablation. JCardiovasc Electrophysiol 2002, 13:764-767.
5. Lee G., Sparks P.B., Morton J.B., et al. Low risk of major complications associated with pulmonary vein antral isolation for atrial fibrillation: results of 500 consecutive ablation procedures in patients with low prevalence of structural heart disease from a single center. JCardiovasc Electrophysiol 2011, 22:163-168.
6. Hoyt H., Bhonsale A., Chilukuri K., et al. Complications arising from catheter ablation of atrial fibrillation: temporal trends and predictors. Heart Rhythm 2011, 8(12):1869-1874.
7. Oral H., Chugh A., Özaydin M., et al. Risk of thromboembolic events after percutaneous left atrial radiofrequency ablation of atrial fibrillation. Circulation 2006, 114:759-765.
8. Cappato R., Calkins H., Chen S.A., et al. Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation. JAm Coll Cardiol 2009, 53:1798-1803.
9. Patel D., Bailey S.M., Furlan A.J., et al. Long-term functional and neurocognitive recovery in patients who had an acute cerebrovascular event secondary to catheter ablation for atrial fibrillation. JCardiovasc Electrophysiol 2010, 21:412-417.
10. Lickfett L., Hackenbroch M., Lewalter T., et al. Cerebral diffusion-weighted magnetic resonance imaging: a tool to monitor the thrombogenicity of left atrial catheter ablation. JCardiovasc Electrophysiol 2006, 17:1-7.
11. Schrickel J.W., Lickfett L., Lewalter T., et al. Incidence and predictors of silent cerebral embolism during pulmonary vein catheter ablation for atrial fibrillation. Europace 2010, 12:52-57.
12. Gaita F., Caponi D., Pianelli M., et al. Radiofrequency catheter ablation of atrial fibrillation: a cause of silent thromboembolism? Magnetic resonance imaging assessment of cerebral thromboembolism in patients undergoing ablation of atrial fibrillation. Circulation 2010, 122:1667-1673.
13. Schwarz N., Kuniss M., Nedelmann M., et al. Neuropsychological decline after catheter ablation of atrial fibrillation. Heart Rhythm 2010, 7(12):1761-1767.
14. Neumann T., Kuniss M., Conradi G., et al. MEDAFI-trial (micro-embolization during ablation of atrial fibrillation): comparison of pulmonary vein isolation using cryoballoon technique vs. radiofrequency energy. Europace 2011, 13:37-44.
15. Herrera Siklódy C., Deneke T., Hocini M., et al. Incidence of asymptomatic embolic events following pulmonary vein isolation procedures: comparison between different ablation devices. JAm Coll Cardiol 2011, 58:681-688.
16. Gaita F., Leclercq J.F., Schumacher B., et al. Incidence of silent cerebral thromboembolic lesions after atrial fibrillation ablation may change according to technology used: comparison of irrigated radiofrequency, multipolar nonirrigated catheter and cryoballoon. JCardiovasc Electrophysiol 2011, 22:961-968.
17. Haeusler K.G., Koch L., Herm J., et al. 3 Tesla MRI-detected brain lesions after pulmonary vein isolation for atrial fibrillation: results of the MACPAF study. JCardiovasc Electrophysiol 2013, 24(1):14-21.
18. Deneke T., Shin D.I., Balta O., et al. Post-ablation asymptomatic cerebral lesions-long-term follow-up using magnetic resonance imaging. Heart Rhythm 2011, 8:1705-1711.
19. Haines D.E., Stewart M.T., Barka N.D., et al. Microembolism and catheter ablation II: effects of cerebral microemboli injections in a canine model. Circ Arrhythm Electrophysiol 2013, 6:23-30.
20. Kalantarian S., Stern T.A., Mansour M., et al. Cognitive impairment associated with atrial fibrillation: a meta-analysis. Ann Intern Med 2013, 158(5 Pt 1):338-346.
21. Vermeer S.E., Prins N.D., den Heier T., et al. Silent brain infarcts and the risk of dementia and cognitive decline. NEngl J Med 2013, 348:1215-1222.
22. Gaita F., Corsinovi L., Anselmino M., et al. Prevalence of silent cerebral ischemia in paroxysmal and persistent atrial fibrillation and correlation with cognitive function. JAm Coll Cardiol 2013, 10.1016/jacc2013.05.074.
23. Medi C., Evered L., Silbert B., et al. Subtle post-procedural cognitive dysfunction after atrial fibrillation ablation. JAm Coll Cardiol 2013, 62:531-539.
24. Feld G.K., Tiongson J., Oshodi G. Particle formation and risk of embolization during transseptal catheterization: comparison of standard transseptal needles and a new radiofrequency transseptal needle. JInterv Card Electrophysiol 2011, 30:31-36.
25. Greenstein E., Passman R., Lin A.C., et al. Knight incidence of tissue coring during transseptal catheterization when using electrocautery and a standard transseptal needle. Circ Arrhythm Electrophysiol 2012, 5(2):341-344.
26. Zhou L., Keane D., Reed G., et al. Thromboembolic complications of cardiac radiofrequency catheter ablation: a review of the reported incidence, pathogenesis and current research directions. JCardiovasc Electrophysiol 1999, 10(4):611-620.
27. Khairy P., Chauvet P., Lehmann J., et al. Lower incidence of thrombus formation with cryoenergy versus radiofrequency catheter ablation. Circulation 2003, 107(15):2045-2050.
28. Di Biase L., Natale A., Barrett C., et al. Relationship between catheter forces, lesion characteristics, "popping," and char formation: experience with robotic navigation system. JCardiovasc Electrophysiol 2009, 20(4):436-440.
29. Nath S., DiMarco J.P., Haines D.E. Basic aspects of radiofrequency catheter ablation. JCardiovasc Electrophysiol 1994, 5(10):863-876.
30. Sauren L.D., Van Belle Y., De Roy L., et al. Transcranial measurement of cerebral microembolic signals during endocardial pulmonary vein isolation: comparison of 3 different ablation techniques. JCardiovasc Electrophysiol 2009, 20(10):1102-1107.
31. Nesbitt W.S., Mangin P., Salem H.H., et al. The impact of blood rheology on the molecular and cellular events underlying arterial thrombosis. JMol Med 2006, 84:989-995.
32. Van Oeveren W., Crijns H.J., Korteling B.J., et al. Blood damage, platelet and clotting activation during application of radiofrequency or cryoablation catheters: a comparative invitro study. JMed Eng Technol 1999, 23(1):20-25.
33. Dorbala S., Cohen A.J., Hutchinson L.A., et al. Does radiofrequency ablation induce a prethrombotic state? Analysis of coagulation system activation and comparison to electrophysiologic study. JCardiovasc Electrophysiol 1998, 9(11):1152-1160.
34. Ren J.F., Marchlinski F.E., Callans D.J. Left atrial thrombus associated with ablation for atrial fibrillation: identification with intracardiac echocardiography. JAm Coll Cardiol 2004, 43:1861-1867.
35. Haines D.E., Stewart M.T., Ahlberg S., et al. Microembolism and catheter ablation I: a comparison of irrigated radiofrequency and multielectrode-phased radiofrequency catheter ablation of pulmonary vein ostia. Circ Arrhythm Electrophysiol 2013, 6:16-22.
36. Nagy-Baló E., Tint D., Clemens M., et al. Transcranial measurement of cerebral microembolic signals during pulmonary vein isolation: a comparison of two ablation techniques. Circ Arrhythm Electrophysiol 2013, 6:473-480.
37. Kalman J.M., Fitzpatrick A.P., Olgin J.E., et al. Biophysical characteristics of radiofrequency lesion formation invivo: dynamics of catheter tip-tissue contact evaluated by intracardiac echocardiography. Am Heart J 1997, 133(1):8-18.
38. Johansen P. Mechanical heart valve cavitation. Expert Rev Med Devices 2004, 1(1):95-104.
39. Szili-Torok T., Kimman G.P., Theuns D., et al. Visualisation of intracardiac structures and radiofrequency lesions using intracardiac echocardiography. Eur J Echocardiogr 2003, 4:17-22.
40. Marrouche N.S., Martin D.O., Wazni O., et al. Phased-array intracardiac echocardiography monitoring during pulmonary vein isolation in patients with atrial fibrillation: impact on outcome and complications. Circulation 2006, 107:2710-2716.
41. Ringelstein E.B., Droste D.W., Babikian W.L., et al. Consensus on microembolus detection by TCD. International consensus group on microembolus detection. Stroke 1998, 29:725-729.
42. Grosset D.G., Georgiadis G., Kelman A.W., et al. Detection of microemboli by transcranial Doppler ultrasound. Tex Heart Inst J 1996, 23:289-292.
43. Russell D., Brucher R. Online automatic discrimination between solid and gaseous cerebral microemboli with the first multifrequency transcranial Doppler. Stroke 1998, 29:725-729.
44. Borger M.A., Peniston C.M., Weisel R.D., et al. Neurophysiologic impairment after coronary bypass surgery: effect of gaseous microemboli during perfusionist interventions. JThorac Cardiovasc Surg 2001, 121:743-749.
45. Kilicaslan F., Verma A., Saad E., et al. Transcranial Doppler detection of microembolic signals during pulmonary vein antrum isolation: implications for titration of radiofrequency energy. JCardiovasc Electrophysiol 2006, 17:495-501.
46. Sauren L.D., La Meir M., de Roy L., et al. Increased number of cerebral emboli during percutaneous endocardial pulmonary vein isolation versus a thoracoscopic epicardial approach. Eur J Cardiothorac Surg 2009, 36:833-837.
47. Di Biase L., Burkhardt J.D., Mohanty P., et al. Periprocedural stroke and management of major bleeding complications in patients undergoing catheter ablation of atrial fibrillation: the impact of periprocedural therapeutic international normalized ratio. Circulation 2010, 121:2550-2556.
48. Scherr D., Sharma K., Dalal D., et al. Incidence and predictors of periprocedural cerebrovascular accident in patients undergoing catheter ablation of atrial fibrillation. JCardiovasc Electrophysiol 2009, 20(12):1357-1363.
49. Ichiki H., Oketani N., Ishida S., et al. Incidence of asymptomatic cerebral microthromboembolism after atrial fibrillation ablation guided by complex fractionated atrial electrogram. JCardiovasc Electrophysiol 2012, 23(6):567-573.
50. Calkins H., Kuck K.H., Cappato R., et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Heart Rhythm 2012, 9(4):632-689.
51. Wieczorek M., Lukat M., Hoeltgen R., et al. Investigation into causes of abnormal cerebral MRI findings following PVAC duty cycled phased RF ablation of atrial fibrillation. JCardiovasc Electrophysiol 2013, 24(2):121-128.
52. Wieczorek M., Hoeltgen R., Brueck M. Does the number of simultaneously activated electrodes during phased RF multielectrode ablation of atrial fibrillation influence the incidence of silent cerebral microembolism?. Heart Rhythm 2013, 10(10):953-959.
53. American College of Cardiology Foundation, American Heart Association, European Society of Cardiology, Heart Rhythm Society, Wann L.S., Curtis A.B., Ellenbogen K.A., et al. Management of patients with atrial fibrillation (Compilation of 2006 ACCF/AHA/ESC and 2011 ACCF/AHA/HRS Recommendations): a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2013, 127:1916-1926.
54. European Heart Rhythm Association, European Association for Cardio-Thoracic Surgery, Camm A.J., Kirchhof P., Lip G.Y., et al. Guidelines for the management of atrial fibrillation. The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology. Eur Heart J 2010, 31:2369-2429.
55. Wazni O.M., Beheiry S., Fahmy T., et al. Atrial fibrillation ablation in patients with therapeutic international normalized ratio: comparison of strategies of anticoagulation management in the periprocedural period. Circulation 2007, 116:2531-2534.
56. Hussein A.A., Martin D.O., Patel D., et al. Radiofrequency ablation of atrial fibrillation under therapeutic international normalized ratio: a safe and efficacious periprocedural anticoagulation strategy. Heart Rhythm 2009, 6:1425-1429.
57. Lakkireddy D., Reddy Y.M., Di Biase L., et al. Feasibility and safety of dabigatran versus warfarin for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation. results from a multicenter prospective registry. JAm Coll Cardiol 2012, 59:1168-1174.
58. Winkle R.A., Mead R.H., Engel G., et al. The use of dabigatran immediately after atrial fibrillation ablation. JCardiovasc Electrophysiol 2011, 23:264-268.
59. Lakkireddy D., Reddy Y.M., Vallakati A., et al. Feasibility and safety of uninterrupted rivaroxaban for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation: results from a multicenter prospective registry. J Am Coll Cardiol 2012, 13:1168-1174.
60. Romero J., Husain S.A., Kelesidis I., et al. Detection of left atrial appendage thrombus by cardiac computed tomography in patients with atrial fibrillation: a meta-analysis. Circ Cardiovasc Imaging 2013, 6(2):185-194.
61. Sawit S.T., Garcia-Alvarez A., Suri B., et al. Usefulness of cardiac computed tomographic delayed contrast enhancement of the left atrial appendage before pulmonary vein ablation. Am J Cardiol 2012, 109:677-684.
62. Hur J., Pak H.N., Kim Y.J., et al. Dual-enhancement cardiac computed tomography for assessing left atrial thrombus and pulmonary veins before radiofrequency catheter ablation for atrial fibrillation. Am J Cardiol 2013, 112:238-244.
63. Ren J.F., Marchlinski F.E., Supple G.E., et al. Intracardiac echocardiographic diagnosis of thrombus formation in the left atrial appendage: a complementary role to transesophageal echocardiography. Echocardiography 2013, 30:72-80.
64. Bruce C.J., Friedman P.A., Narayan O., et al. Early heparinization decreases the incidence of left atrial thrombi detected by intracardiac echocardiography during radiofrequency ablation for atrial fibrillation. JInterv Card Electrophysiol 2008, 22:211-219.
65. Camm A.J., Lip G.Y., De Caterina R., et al. 2012 focused update of the ESC guidelines for the management of atrial fibrillation. Eur Heart J 2012, 33:2719-2747.
66. Chao T.F., Lin Y.J., Tsao H.M., et al. CHADS2 and CHA2DS2-VASc scores in the prediction of clinical outcomes in patients with atrial fibrillation after catheter ablation. JAm Coll Cardiol 2011, 58:2380-2385.
67. Themistoclakis S., Corrado A., Marchlinski F.E., et al. The risk of thromboembolism and need for oral anticoagulation after successful atrial fibrillation ablation. JAm Coll Cardiol 2010, 55:735-743.