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Factors Associated with Silent Cerebral Events During Atrial Fibrillation Ablation in Patients on Uninterrupted Oral Anticoagulation
  • +7
  • Masahide Harada,
  • Yuji Motoike,
  • Yoshihiro Nomura,
  • Asuka Nishimura,
  • Masayuki Koshikawa,
  • Kazuhiro Murayama,
  • Yoshiharu Ohno,
  • Eiichi Watanabe,
  • Yukio Ozaki,
  • Hideo Izawa
Masahide Harada
Fujita Health University
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Yuji Motoike
Fujita Health University
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Yoshihiro Nomura
Fujita Health University
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Asuka Nishimura
Fujita Health University
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Masayuki Koshikawa
Fujita Health University
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Kazuhiro Murayama
Fujita Health University
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Yoshiharu Ohno
Fujita Health University
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Eiichi Watanabe
Fujita Health University School of Medicine
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Yukio Ozaki
Fujita Health University School of Medicine
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Hideo Izawa
Fujita Health University
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Abstract

Introduction: Silent cerebral events (SCEs) are related to the potential thromboembolic risk in atrial fibrillation (AF) ablation. Peri-procedural uninterrupted oral anticoagulation (OAC) reportedly reduced the risk of SCEs, but the incidence still remains. Methods and Results: AF patients undergoing catheter ablation were eligible. All patients took non-vitamin K antagonist oral anticoagulants (NOACs, n=248) or vitamin K antagonist (VKA, n=37) for peri-procedural OAC (>4 weeks) without interruption during the procedure. Brain magnetic resonance imaging was performed within 2 days after the procedure to detect SCEs. Clinical characteristics and procedure-related parameters were compared between patients with and without SCEs. SCEs were detected in 66 patients (23.1%, SCE[+]) but were not detected in 219 patients (SCE[-]). Average age was higher in SCE[+] than in SCE[-] (66±10 years vs. 62±12 years, p<0.05). Persistent AF prevalence, CHADS2/CHA2DS2-VASc scores, serum NT-ProBNP levels, left-atrial dimension (LAD), and spontaneous echo contrast prevalence in transesophageal echocardiography significantly increased in SCE[+] vs. SCE[-]. SCE[+] had lower baseline activated clotting time (ACT) before heparin injection and longer time to reach optimal ACT (>300 sec) than SCE [-] (146±27 sec vs. 156±29 sec and 44±30 sec vs. 35±25 sec, p<0.05, respectively). In multivariate analysis, LAD, baseline ACT, and time to reach the optimal ACT were predictors for SCEs. The average values of the ACT parameters were significantly different among NOACs/VKA. Conclusion: LAD and intra-procedural ACT kinetics significantly affect SCEs during AF ablation. Different anticoagulants have different impacts on ACT during the procedure, which should be considered when estimating the risk of SCEs.

Peer review status:ACCEPTED

07 Apr 2020Submitted to Journal of Cardiovascular Electrophysiology
08 Apr 2020Submission Checks Completed
08 Apr 2020Assigned to Editor
08 Apr 2020Reviewer(s) Assigned
06 May 2020Review(s) Completed, Editorial Evaluation Pending
07 May 2020Editorial Decision: Revise Minor
03 Jul 20201st Revision Received
03 Jul 2020Assigned to Editor
03 Jul 2020Submission Checks Completed
03 Jul 2020Reviewer(s) Assigned
18 Jul 2020Review(s) Completed, Editorial Evaluation Pending
20 Jul 2020Editorial Decision: Revise Minor
29 Jul 20202nd Revision Received
30 Jul 2020Submission Checks Completed
30 Jul 2020Assigned to Editor
30 Jul 2020Reviewer(s) Assigned
07 Aug 2020Review(s) Completed, Editorial Evaluation Pending
08 Aug 2020Editorial Decision: Accept