Division of Cardiology, Cardiac Arrhythmia Service, Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA.
Electrophysiology Unit, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India.
JACC Clin Electrophysiol. 2021 Dec;7(12):1493-1501. doi: 10.1016/j.jacep.2021.07.010. Epub 2021 Jul 29.
The STROKE-VT (Safety and Efficacy of Direct Oral Anticoagulant Versus Aspirin for Reduction of Risk of Cerebrovascular Events in Patients Undergoing Ventricular Tachycardia Ablation) study is a multicenter, randomized controlled trial that examined the differences in cerebrovascular events between direct oral anticoagulant (DOAC) and aspirin (ASA) use postprocedurally in patients who underwent left ventricular arrhythmia (LVA) ablation (ventricular tachycardia [VT] or premature ventricular contraction [PVC]) using radiofrequency ablation (RFA).
There exists limited data regarding antiplatelet or anticoagulation strategy following LVA ablation.
A total of 246 patients scheduled for LVA-RFA were randomized 1:1 postprocedurally to receive DOACs or ASA. The study's primary endpoint was the incidence of stroke or transient ischemic attack (TIA) or asymptomatic cerebrovascular events (ACEs) detected by magnetic resonance imaging at 24 hours and 30 days of follow-up. The secondary endpoints included procedure-related complications (composite of any vascular complication, pericardial complication, heart block, and thromboembolic event, excluding stroke or TIA) and in-hospital mortality.
There were no differences between groups regarding baseline and ablation characteristics (except the percentage of patients who underwent VT ablation, rate of amiodarone use, and total RFA time). Postprocedure cerebrovascular events (stroke and TIA) were lower in the DOAC arm versus the ASA arm (0% vs 6.5%; P < 0.001 and 4.9% vs. 18%; P < 0.001, respectively). Patients in the ASA group had more MRI-detected ACEs compared with the DOAC group both at 24-hour (23% vs 12%; P = 0.03) and 30-day (18% vs 6.5%; P = 0.006) follow-up. Acute procedure-related complications and in-hospital mortality were similar between the 2 groups.
DOAC use following endocardial and/or epicardial ablation for LVA-RFA was associated with reduced risk of TIA or stroke and asymptomatic MRI-detected cerebrovascular events.
STROKE-VT（直接口服抗凝剂与阿司匹林用于降低接受心室性心动过速消融术患者的脑血管事件风险的安全性和有效性）研究是一项多中心、随机对照试验，旨在比较左心室心律失常（LVA）消融术后（室性心动过速[VT]或室性期前收缩[PVC]）患者使用射频消融（RFA）进行心内膜和/或心外膜消融后，直接口服抗凝剂（DOAC）与阿司匹林（ASA）使用在脑血管事件方面的差异。
关于 LVA 消融术后抗血小板或抗凝策略的数据有限。
246 例计划接受 LVA-RFA 的患者在术后按 1:1 随机分为 DOAC 组或 ASA 组。该研究的主要终点是在 24 小时和 30 天随访时通过磁共振成像（MRI）检测到的中风或短暂性脑缺血发作（TIA）或无症状性脑血管事件（ACEs）的发生率。次要终点包括与手术相关的并发症（任何血管并发症、心包并发症、心脏阻滞和血栓栓塞事件的综合，不包括中风或 TIA）和住院死亡率。
两组患者在基线和消融特征方面无差异（除了行 VT 消融术的患者百分比、胺碘酮使用率和总 RFA 时间）。与 ASA 组相比，DOAC 组术后脑血管事件（中风和 TIA）较低（0%比 6.5%；P<0.001 和 4.9%比 18%；P<0.001）。ASA 组在 24 小时（23%比 12%；P=0.03）和 30 天（18%比 6.5%；P=0.006）随访时，MRI 检测到的 ACEs 比 DOAC 组更多。两组之间急性手术相关并发症和住院死亡率相似。
对于接受 LVA-RFA 的心内膜和/或心外膜消融术患者，使用 DOAC 可降低 TIA 或中风和无症状 MRI 检测到的脑血管事件的风险。
