Atrial fibrillation (AF) increases the risk of atrioembolic stroke. However, the role of anticoagulation therapy (OAT) in preventing cerebrovascular accidents (CVA) after intracardiac echocardiography-guided pulmonary vein antrum isolation (ICE-PVAI) is still unclear. In the present study, we evaluated the incidence of CVA following the interruption of OAT 3 months after ICE-PVAI.
Between September 2002 and March 2004, 85 consecutive patients (72 men, mean age 62 +/- 7 years) underwent ICE-PVAI for symptomatic drug-refractory AF. Heart disease was present in 61 patients (72%) (left ventricular ejection fraction = 58 +/- 6%, LA diameter 44 +/- 6 mm). Eighty-five consecutive patients who underwent electrical cardioversion (EC) for AF, matched for age, sex and heart disease, served as a control group. After 3 months, OAT was stopped unless one of the following conditions was observed: (i) AF-recurrence; (ii) severe pulmonary vein stenosis; (iii) non-good atrial contractility on transesophageal echocardiography; or (iv) other indications for OAT.
In the study group, OAT was stopped after 3 months in 77 patients (90%) and no CVA occurred during the remaining follow-up (15 +/- 7 months). In the control group, 1 month after EC, OAT was stopped by the referring physician in 29 patients (34%). A stroke occurred in five patients (6%) (P = 0.09; mean P = 0.059) during follow-up. In two of these (2%), the stroke was fatal.
Stopping OAT 3 months after ICE-PVAI seems to be safe in patients without AF recurrences after the first 3 months following ablation. Further randomized-controlled studies are needed to confirm these preliminary data.
"Rossillo et al. studied patients after catheter ablation and stopped the anticoagulation therapy in patients that were without AF recurrences after the first 3 months following ablation. They could show that those patients had no cerebrovascular accidents within the follow-up (15 ± 7 months) . Another recent study could show that AF ablation patients had a significantly lower risk of stroke compared to AF patients who did not undergo ablation independent of the baseline CHADS score. "
[Show abstract][Hide abstract] ABSTRACT: Atrial fibrillation (AF) is one of the major morbidity and health economic factors in Europe and often associated with several co-morbidities. This paper (1) underlines the importance of highly professional AF management utilising a multi-disciplinary expertise, especially considering the role of AF regarding the stroke risk and prevention, (2) demonstrates the consolidated position of CVD professionals and (3) emphasises those research aspects that could deepen the understanding of the emergence and the treatment of AF and therefore helps to provide a personalised preventive and more effective management of AF. Specialised calls are considered for that within the new European Programme 'Horizon 2020'.
EPMA Journal, The 09/2014; 5(1):15. DOI:10.1186/1878-5085-5-15
[Show abstract][Hide abstract] ABSTRACT: Image integration is used in AF ablation procedures. To maximize the efficacy of image integration, it is essential to obtain good alignment between the electroanatomical map and the 3D image of the heart. In the present study, we compared an ICE-guided landmark registration with an ICE-guided focused endocardial surface registration.
In 20 patients, registration was based on posterior landmarks acquired under ICE guidance (group A); in another 20 matched patients, a new ICE-guided focused endocardial surface registration technique was used (group B). In these latter patients, a single landmark was acquired in the inferior part of the LIPV, and several surface points were recorded in the posterior area of the left PV antrum and around the antra of the right PVs. The mean ablation point-to-CT image distance was calculated in both groups. In group A, the mean landmark point-to-CT image distance was also calculated after adding the surface registration. The mean landmark point-to-CT image distance was 4.62 +/- 1.65 mm and increased to 7.66 +/- 2.44 mm when surface registration was added. The ablation point-to-CT image distance was significantly shorter in group B (1.73 +/- 0.29 mm vs 3 +/- 0.99 mm; P < 0.001).
This ICE-guided focused endocardial surface registration seems to be superior to landmark registration in achieving a better alignment between the CT/MR image and the electroanatomical map. The concurrent use of standard surface registration may result in rotation of the atrial chamber.
[Show abstract][Hide abstract] ABSTRACT: Atrial fibrillation (AF) is the most common clinically significant arrhythmia worldwide, and its incidence is increasing. There has been increasing interest in ablation therapy to treat atrial fibrillation. One reason some patients undergo AF ablation might be to obviate the need for warfarin therapy, although current guidelines do not support this rationale. The current review shows that it is difficult to define a true "cure" postablation, as many of these patients will go on to experience future paroxysms of AF (either symptomatic or silent). The mechanism underlying embolism in patients with AF is not completely understood, and no long-term evidence exists that "successfully ablated" patients return to a baseline risk of stroke comparable to an AF-naive population. The authors recommend continued long-term anticoagulation post-AF ablation in patients satisfying CHADS criteria for elevated stroke risk.
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