室性心律失常心内膜消融的卒中与出血风险

Stroke and Bleeding Risks of Endocardial Ablation for Ventricular Arrhythmias.

作者信息

Hasegawa Kanae, Yoneda Zachary T, Powers Edward M, Tokutake Kenichi, Kurata Masaaki, Richardson Travis D, Montgomery Jay A, Shen Sharon, Estrada Juan C, Saavedra Pablo J, Emerson Amy, Walker Marilyn L, Tandri Harikrishna, Michaud Gregory F, Kanagasundram Arvindh N, Stevenson William G

机构信息

Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.

Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

出版信息

JACC Clin Electrophysiol. 2024 Feb;10(2):193-202. doi: 10.1016/j.jacep.2023.10.011. Epub 2023 Dec 6.

DOI:10.1016/j.jacep.2023.10.011

PMID:38069975

Abstract

BACKGROUND

Risks of radiofrequency catheter ablation for ventricular arrhythmias include emboli and bleeding complications but data on antithrombotic regimens are limited and guidelines do not specify a systematic approach.

OBJECTIVES

This study sought to assess embolic and bleeding complications in relation to pre-periprocedure and post-periprocedure antithrombotic regimens.

METHODS

Prospective assessment for complications was performed for 663 endocardial radiofrequency catheter ablation procedures in 616 consecutive patients (median age 64 years [Q1-Q3: 54-73 years], 70.3% men, 71.6% with cardiomyopathy, 44.5% with sustained ventricular tachycardia).

RESULTS

There were 2 strokes (0.3%; 95% CI: 0.0%-0.8%), 1 transient ischemic attack (0.15%), and 2 pulmonary emboli (0.3%). There were 39 bleeding complications (5.9%) including 11 pericardial effusions (1.7%), and 28 related to vascular access (4.2%). Consistent with the prevalence of coronary artery disease (47.5%), atrial fibrillation (30.0%), and prior stroke (10.6%), preprocedure, 464 patients (70.0%) were taking antithrombotic agents including 220 (33.2%) taking aspirin alone (ASA), and 163 (24.6%) taking warfarin or a direct acting oral anticoagulant (DOAC). Preprocedure non-ASA antiplatelet use (OR: 2.846; P = 0.011) and DOAC use (OR: 2.585; P = 0.032) were associated with risk of bleeding complications. Following ablation, 49.8% of patients were treated with ASA 325 mg/d and 30.3% received DOACs or warfarin. New DOAC or warfarin administration was initiated in only 6.6% of patients. Overall, 39.7% of patients continued the same preprocedure antithrombotic regimen.

CONCLUSIONS

Stroke is a rare complication of radiofrequency catheter ablation for ventricular arrhythmia using ASA 325 mg/d as a minimal postprocedure regimen with more potent regimens for selected patients.

摘要

背景

室性心律失常的射频导管消融术风险包括栓塞和出血并发症，但关于抗血栓治疗方案的数据有限，且指南未明确规定系统的方法。

目的

本研究旨在评估与术前和术后抗血栓治疗方案相关的栓塞和出血并发症。

方法

对616例连续患者（中位年龄64岁[四分位间距：54 - 73岁]，男性占70.3%，71.6%患有心肌病，44.5%患有持续性室性心动过速）的663例心内膜射频导管消融手术进行并发症的前瞻性评估。

结果

发生2例卒中（0.3%；95%置信区间：0.0% - 0.8%）、1例短暂性脑缺血发作（0.15%）和2例肺栓塞（0.3%）。有39例出血并发症（5.9%），包括11例心包积液（1.7%）和28例与血管通路相关的并发症（4.2%）。与冠状动脉疾病（47.5%）、心房颤动（30.0%）和既往卒中（10.6%）的患病率一致，术前，464例患者（70.0%）正在服用抗血栓药物，其中220例（33.2%）仅服用阿司匹林（ASA），163例（24.6%）服用华法林或直接口服抗凝剂（DOAC）。术前非ASA抗血小板药物的使用（比值比：2.846；P = 0.011）和DOAC的使用（比值比：2.585；P = 0.032）与出血并发症风险相关。消融术后，49.8%的患者接受325 mg/d的ASA治疗，30.3%的患者接受DOAC或华法林治疗。仅6.6%的患者开始使用新的DOAC或华法林。总体而言，39.7%的患者继续术前相同的抗血栓治疗方案。