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Cerebral thromboembolic risk in atrial fibrillation ablation: a direct comparison of vitamin K antagonists versus non-vitamin K-dependent oral anticoagulants

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Cerebral thromboembolic events are well-known complications of pulmonary vein isolation (PVI) and can manifest as stroke or silent cerebral embolic lesions. The aim of this study was to compare the incidence of cerebral embolic lesions (including silent cerebral embolism and stroke) after AF ablation in patients on vitamin K antagonists versus patients on non-vitamin K-dependent oral anticoagulants, and to identify corresponding clinical and procedural risk factors.

Methods

A total of 421 patients undergoing PVI were prospectively included into the study. Of these, 43.7% were on VKA and 56.3% on NOAC treatment (dabigatran, rivaroxaban, apixaban, and edoxaban). In the NOAC group, 38% of patients had an interruption of anticoagulation for 24–36 h. All patients underwent pre- and postprocedural cerebral magnetic resonance imaging.

Results

Periprocedural cerebral lesions occurred in 13.1% overall. Of these, three (0.7%) resulted in symptomatic cerebrovascular accidents and 52 (12.4%) in silent cerebral embolic lesions. Incidence of cerebral lesions was significantly higher in patients on NOAC compared with VKA (16% vs. 9.2%, respectively, p = 0.04), and in patients who had intraprocedural cardioversions compared with no cardivoersions (19.5% vs. 10.4%, respectively, p = 0.03). In multivariate analysis, both parameters were found to be independent risk factors for cerebral embolism. No significant difference between interrupted and uninterrupted NOAC administration could be detected.

Conclusions

In patients undergoing AF ablation, we identified the use of NOAC and intraprocedural cardioversion as independent risk factors for the occurrence of periprocedural cerebral embolic lesions.

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Author notes

  1. Adrian Petzl and Michael Derndorfer contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine 2 with Cardiology, Angiology and Intensive Care, Ordensklinikum Linz Elisabethinen, Fadingerstraße 1, A-4020, Linz, Austria

    Adrian Petzl, Michael Derndorfer, Georgios Kollias, Kgomotso Moroka, Josef Aichinger, Helmut Pürerfellner & Martin Martinek

  2. Department of Internal Medicine 3, University Hospital St. Pölten, Dunant-Platz 1, A-3100, St. Pölten, Austria

    Adrian Petzl & Martin Martinek

Authors
  1. Adrian Petzl
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  2. Michael Derndorfer
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  3. Georgios Kollias
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  4. Kgomotso Moroka
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  5. Josef Aichinger
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  6. Helmut Pürerfellner
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  7. Martin Martinek
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Correspondence to Adrian Petzl.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the national research committee (Ethikkommission des Landes Oberösterreich (Ethics Commission of the State of Upper Austria), ethics committee vote reference number K-103-16) and with the 1964 Helsinki declaration and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Petzl, A., Derndorfer, M., Kollias, G. et al. Cerebral thromboembolic risk in atrial fibrillation ablation: a direct comparison of vitamin K antagonists versus non-vitamin K-dependent oral anticoagulants. J Interv Card Electrophysiol 60, 147–154 (2021). https://doi.org/10.1007/s10840-020-00718-w

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  • DOI: https://doi.org/10.1007/s10840-020-00718-w

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