Journal article
Stroke and Bleeding Risks of Endocardial Ablation for Ventricular Arrhythmias
JACC: Clinical Electrophysiology, Vol.10(2), pp.193-202
02/01/2024
DOI: 10.1016/j.jacep.2023.10.011
PMID: 38069975
Abstract
Background
Risks of radiofrequency catheter ablation for ventricular arrhythmias include emboli and bleeding complications but data on antithrombotic regimens are limited and guidelines do not specify a systematic approach.
Objectives
This study sought to assess embolic and bleeding complications in relation to pre-periprocedure and post-periprocedure antithrombotic regimens.
Methods
Prospective assessment for complications was performed for 663 endocardial radiofrequency catheter ablation procedures in 616 consecutive patients (median age 64 years [Q1-Q3: 54-73 years], 70.3% men, 71.6% with cardiomyopathy, 44.5% with sustained ventricular tachycardia).
Results
There were 2 strokes (0.3%; 95% CI: 0.0%-0.8%), 1 transient ischemic attack (0.15%), and 2 pulmonary emboli (0.3%). There were 39 bleeding complications (5.9%) including 11 pericardial effusions (1.7%), and 28 related to vascular access (4.2%). Consistent with the prevalence of coronary artery disease (47.5%), atrial fibrillation (30.0%), and prior stroke (10.6%), preprocedure, 464 patients (70.0%) were taking antithrombotic agents including 220 (33.2%) taking aspirin alone (ASA), and 163 (24.6%) taking warfarin or a direct acting oral anticoagulant (DOAC). Preprocedure non-ASA antiplatelet use (OR: 2.846; P = 0.011) and DOAC use (OR: 2.585; P = 0.032) were associated with risk of bleeding complications. Following ablation, 49.8% of patients were treated with ASA 325 mg/d and 30.3% received DOACs or warfarin. New DOAC or warfarin administration was initiated in only 6.6% of patients. Overall, 39.7% of patients continued the same preprocedure antithrombotic regimen.
Conclusions
Stroke is a rare complication of radiofrequency catheter ablation for ventricular arrhythmia using ASA 325 mg/d as a minimal postprocedure regimen with more potent regimens for selected patients.
Details
- Title: Subtitle
- Stroke and Bleeding Risks of Endocardial Ablation for Ventricular Arrhythmias
- Creators
- Kanae Hasegawa - Vanderbilt University Medical CenterZachary T. Yoneda - Vanderbilt University Medical CenterEdward M. Powers - Vanderbilt University Medical CenterKenichi Tokutake - Vanderbilt University Medical CenterMasaaki Kurata - Vanderbilt University Medical CenterTravis D. Richardson - Vanderbilt University Medical CenterJay A Montgomery - Vanderbilt University Medical CenterSharon Shen - Vanderbilt University Medical CenterJuan C. Estrada - Vanderbilt University Medical CenterPablo J. Saavedra - Vanderbilt University Medical CenterAmy Emerson - Vanderbilt University Medical CenterMarilyn L. Walker - Vanderbilt University Medical CenterHarikrishna Tandri - Vanderbilt University Medical CenterGregory F. Michaud - Vanderbilt University Medical CenterArvindh N. Kanagasundram - Vanderbilt University Medical CenterWilliam G. Stevenson - Vanderbilt University Medical Center
- Resource Type
- Journal article
- Publication Details
- JACC: Clinical Electrophysiology, Vol.10(2), pp.193-202
- DOI
- 10.1016/j.jacep.2023.10.011
- PMID
- 38069975
- NLM abbreviation
- JACC Clin Electrophysiol
- ISSN
- 2405-500X
- eISSN
- 2405-5018
- Publisher
- Elsevier BV; AMSTERDAM
- Grant note
- Japanese Heart Rhythm SocietyAbbottJohnson and JohnsonMedtronicAbbott and Johnson and JohnsonBiotronik
Dr Hasegawa has received funding from the International Rotary Fellowship of Health Professionals. Drs Tokutake and Kurata have received a scholarship from the Japanese Heart Rhythm Society. Dr Richardson has served as a consultant for Medtronic, Johnson and Johnson, and Philips; and has received research funding from Medtronic and Abbott. Dr Michaud has received honoraria from Boston Scientific, Abbott, Johnson and Johnson, and Medtronic; and has served as a consultant for Boston Scientific, Abbott, Johnson and Johnson, and GE. Dr Kanagasundram has received speaker fees from Abbott and Johnson and Johnson. Dr Stevenson has received honoraria from Boston Scientific, Abbott, Johnson and Johnson, Medtronic, and Biotronik; and is coholder of a patent for irrigated needle ablation that is consigned to Brigham Hospital. All other authors have reported that they have no relationships relevant to the contents of this to disclose.r received a scholarship from the Japanese Heart Rhythm Society. Dr Richardson has served as a consultant for Medtronic, Johnson and Johnson, and Philips; and has received research funding from Med-tronic and Abbott. Dr Michaud has received honoraria from Boston Scientific, Abbott, Johnson and Johnson, and Medtronic; and has served as a consultant for Boston Scientific, Abbott, Johnson and Johnson, and GE. Dr Kanagasundram has received speaker fees from Abbott and Johnson and Johnson. Dr Stevenson has received hono-raria from Boston Scientific, Abbott, Johnson and Johnson, Med-tronic, and Biotronik; and is co-holder of a patent for irrigated needle ablation that is consigned to Brigham Hospital. All other authors have reported that they have no relationships relevant to the contents of this to disclose.
- Language
- English
- Date published
- 02/01/2024
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984802502802771
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