Executive Texas Cardiac Arrhythmia Institute, St David's Medical Center, 1015 E 32th St, Suite 516, Austin, TX 78705, USA.
Circulation. 2010 Jun 15;121(23):2550-6. doi: 10.1161/CIRCULATIONAHA.109.921320. Epub 2010 Jun 1.
Catheter ablation of atrial fibrillation is associated with the potential risk of periprocedural stroke, which can range between 1% and 5%. We developed a prospective database to evaluate the prevalence of stroke over time and to assess whether the periprocedural anticoagulation strategy and use of open irrigation ablation catheter have resulted in a reduction of this complication.
We collected data from 9 centers performing the same ablation procedure with the same anticoagulation protocol. We divided the patients into 3 groups: ablation with an 8-mm catheter off warfarin (group 1), ablation with an open irrigated catheter off warfarin (group 2), and ablation with an open irrigated catheter on warfarin (group 3). Outcome data on stroke/transient ischemic attack and bleeding complications during and early after the procedures were collected. Of 6454 consecutive patients in the study, 2488 were in group 1, 1348 were in group 2, and 2618 were in group 3. Periprocedural stroke/transient ischemic attack occurred in 27 patients (1.1%) in group 1 and 12 patients (0.9%) in group 2. Despite a higher prevalence of nonparoxysmal atrial fibrillation and more patients with CHADS2 (congestive heart failure, hypertension, age >75 years, diabetes mellitus, and prior stroke or transient ischemic attack) score >2, no stroke/transient ischemic attack was reported in group 3. Complications among groups 1, 2, and 3, including major bleeding (10 [0.4%], 11 [0.8%], and 10 [0.4%], respectively; P>0.05) and pericardial effusion (11 [0.4%], 11 [0.8%], and 12 [0.5%]; P>0.05), were equally distributed.
The combination of an open irrigation ablation catheter and periprocedural therapeutic anticoagulation with warfarin may reduce the risk of periprocedural stroke without increasing the risk of pericardial effusion or other bleeding complications.
房颤导管消融术与围手术期卒中的潜在风险相关，风险范围为 1%至 5%。我们开发了一个前瞻性数据库，以评估随着时间推移卒中的发生率，并评估围手术期抗凝策略和使用开放式灌流消融导管是否降低了这种并发症的发生。
我们从 9 个中心收集了进行相同消融手术且采用相同抗凝方案的患者数据。我们将患者分为 3 组：未使用华法林的 8mm 消融导管消融组（第 1 组）、未使用华法林的开放式灌流消融导管消融组（第 2 组）和使用华法林的开放式灌流消融导管消融组（第 3 组）。收集围手术期及术后早期卒中/短暂性脑缺血发作和出血并发症的数据。在研究的 6454 例连续患者中，2488 例在第 1 组，1348 例在第 2 组，2618 例在第 3 组。第 1 组中有 27 例（1.1%）和第 2 组中有 12 例（0.9%）患者发生围手术期卒中/短暂性脑缺血发作。尽管第 3 组患者中非阵发性房颤的比例较高，且 CHADS2 评分（充血性心力衰竭、高血压、年龄>75 岁、糖尿病和既往卒中或短暂性脑缺血发作）>2 的患者更多，但未报告卒中/短暂性脑缺血发作。第 1、2 和 3 组的并发症，包括大出血（10 例[0.4%]、11 例[0.8%]和 10 例[0.4%]；P>0.05）和心包积液（11 例[0.4%]、11 例[0.8%]和 12 例[0.5%]；P>0.05）的发生率相似。
开放式灌流消融导管与围手术期华法林治疗性抗凝相结合，可能降低围手术期卒中风险，而不增加心包积液或其他出血并发症的风险。
