Predictors of asymptomatic cerebral infarction associated with radiofrequency catheter ablation for atrial fibrillation using an irrigated-tip catheter.

Tamotsu Sakamoto, Koji Kumagai, Suguru Nishiuchi, Etsuko Fuke, Yuko Miki, Keijiro Nakamura, Kenichi Kaseno, Keiko Koyama, Shigeto Naito, Hiroshi Inoue, Shigeru Oshima

Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumimachi-kou, Maebashi 371-0004, Japan.

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 2013 Mar

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Catheter ablation is a potentially curative treatment for atrial fibrillation (AF). However, complications such as ischaemic stroke are more frequent and more severe compared with ablation procedures for other arrhythmias. Irrigated-tip catheters have been reported to reduce the risk of stroke. The present study aimed to evaluate predictors of asymptomatic cerebral infarction (CI) after AF ablation using an irrigated-tip catheter. A total of 70 consecutive AF patients who underwent catheter ablation were subjected to brain magnetic resonance imaging (MRI) 1 day after the procedure. In 10 (14.3%) of 70 patients, MRI revealed acute CI, but neither symptoms nor abnormal neurological findings were present in these patients. In univariate analysis, a history of persistent AF, left atrial dimension, presence of spontaneous echo contrast (SEC), procedure duration prior to heparin injection, and electrical cardioversion during the procedure differed significantly between the two groups, those with and without CI (P = 0.02, 0.05, 0.01, 0.01, and 0.05, respectively). Multivariate logistic regression analysis identified SEC [odds ratio (OR), 9.39; 1.60-55.2; P = 0.01] and procedure duration prior to heparin injection (OR, 1.19; 1.04-1.36; P = 0.01) as predictive of acute asymptomatic CI after AF ablation. The presence of SEC and procedure duration prior to heparin injection are determinants of asymptomatic CI during AF ablation despite the use of an irrigated-tip catheter.

Citation

Tamotsu Sakamoto, Koji Kumagai, Suguru Nishiuchi, Etsuko Fuke, Yuko Miki, Keijiro Nakamura, Kenichi Kaseno, Keiko Koyama, Shigeto Naito, Hiroshi Inoue, Shigeru Oshima. Predictors of asymptomatic cerebral infarction associated with radiofrequency catheter ablation for atrial fibrillation using an irrigated-tip catheter. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2013 Mar;15(3):332-8