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P472Cerebral thromboembolic risk in atrial fibrillation ablation: a direct comparison of vitamin K antagonists versus non-vitamin K-dependent oral anticoagulants

Authors:
A M Petzl
A M Petzl
A M Petzl
  • This person is not on ResearchGate, or hasn't claimed this research yet.
M Derndorfer
M Derndorfer
M Derndorfer
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Georgios Kollias at Evangelismos Hospital
Georgios Kollias
Kgomotso Moroka at University of Alcalá
Kgomotso Moroka
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Abstract

Aims Cerebral thromboembolic events are well-known complications of pulmonary vein isolation (PVI) and can manifest as stroke or silent cerebral embolic lesions. Over the last years, the preferred oral anticoagulation in atrial fibrillation (AF) shifted from vitamin K antagonists (VKA) to non-vitamin K-dependent oral anticoagulants (NOAC). The aim of this study was to compare the incidence of cerebral embolic lesions after AF ablation in patients on VKA versus patients on NOAC, and to identify corresponding clinical and procedural risk factors. Methods A total of 421 patients undergoing PVI (by radiofrequency catheter or cryoballoon) were prospectively included into the study. Of these, 43.7% were on VKA and 56.3% on NOAC treatment. In the NOAC group 38% of patients had an interruption of anticoagulation for 24-36 hours. 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. Incidence of cerebral lesions was significantly higher in patients on NOAC compared to VKA (16% vs. 9.2% respectively, p = 0.04), as well as in patients that had intraprocedural cardioversions compared to 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. Abstract Figure. Incidence of cerebral embolic lesions

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A Comprehensive Review on Medical Imaging Technologies to Detect Brain Stroke
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Brain stroke discovery remains one of the foremost critical investigation zones in restorative imaging. A brain stroke can be classified into two primary categories Ischemic and Haemorrhagic. Imaging technology detects strokes early. When it comes to imaging, the American College of Radiology persistently overhauls its rules for imaging pathways through the ACR Fittingness Criteria. There are a few prevalent restorative imaging methods for brain stroke locations like X-ray, computed tomography, positron outflow tomography, attractive reverberation imaging, and utilitarian attractive reverberation imaging. MRI and fMRI, using radio waves and a magnet, provide a detailed image of the brain, detecting a wide variety of brain tissues and blood vessel anomalies, including those in regions undetectable by CT (Computed tomography) scans. Advanced technology is making medical imaging crucial in emergencies, with faster scans and better stroke detection. Therefore, MRI and/or fMRI remain the best imaging technologies for detecting strokes.
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