This Article Full Text Full Text (PDF) All Versions of this Article: 114/8/759    most recent CIRCULATIONAHA.106.641225v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Oral, H. Articles by Morady, F. Search for Related Content PubMed PubMed Citation Articles by Oral, H. Articles by Morady, F. Related Collections Ablation/ICD/surgery Acute Stroke Syndromes Arrhythmias, clinical electrophysiology, drugs Related Article

(Circulation. 2006;114:759-765.)
© 2006 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Risk of Thromboembolic Events After Percutaneous Left Atrial Radiofrequency Ablation of Atrial Fibrillation

Hakan Oral, MD; Aman Chugh, MD; Mehmet Özaydn, MD; Eric Good, DO; Jackie Fortino, RN; Sundar Sankaran, MD; Scott Reich, MD; Petar Igic, MD; Darryl Elmouchi, MD; David Tschopp, MD; Alan Wimmer, MD; Sujoya Dey, MD; Thomas Crawford, MD; Frank Pelosi, Jr, MD; Krit Jongnarangsin, MD; Frank Bogun, MD; Fred Morady, MD

From the Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.

Correspondence to Hakan Oral, MD, Cardiology, TC B1 140D 1500 East Medical Center Drive, Ann Arbor, MI 48109-0311. E-mail oralh{at}umich.edu

Received May 20, 2006; revision received June 18, 2006; accepted June 23, 2006.

Background— In patients with atrial fibrillation (AF), the risk of thromboembolic events (TEs) is variable and is influenced by the presence and number of comorbid conditions. The effect of percutaneous left atrial radiofrequency ablation (LARFA) of AF on the risk of TEs is unclear.

Methods and Results— LARFA was performed in 755 consecutive patients with paroxysmal (n=490) or chronic (n=265) AF. Four hundred eleven patients (56%) had 1 risk factor for stroke. All patients were anticoagulated with warfarin for 3 months after LARFA. A TE occurred in 7 patients (0.9%) within 2 weeks of LARFA. A late TE occurred 6 to 10 months after ablation in 2 patients (0.2%), 1 of whom still had AF, despite therapeutic anticoagulation in both. Among 522 patients who remained in sinus rhythm after LARFA, warfarin was discontinued in 79% of 256 patients without risk factors and in 68% of 266 patients with 1 risk factor. Patients older than 65 years or with a history of stroke were more likely to remain anticoagulated despite a successful outcome from LARFA. None of the patients in whom anticoagulation was discontinued had a TE during 25±8 months of follow-up.

Conclusions— The risk of a TE after LARFA is 1.1%, with most events occurring within 2 weeks after the procedure. Discontinuation of anticoagulant therapy appears to be safe after successful LARFA, both in patients without risk factors for stroke and in patients with risk factors other than age >65 years and history of stroke. Sufficient safety data are as yet unavailable to support discontinuation of anticoagulation in patients older than 65 years or with a history of stroke.

---

 

CLINICAL PERSPECTIVE

Related Article:

Issue Highlights
Circulation 2006 114: 753. [Extract] [Full Text]

This article has been cited by other articles:

				S. Puwanant, B. C. Varr, K. Shrestha, S. K. Hussain, W.H. W. Tang, R. S. Gabriel, O. M. Wazni, M. Bhargava, W. I. Saliba, J. D. Thomas, et al. Role of the CHADS(2) Score in the Evaluation of Thromboembolic Risk in Patients With Atrial Fibrillation Undergoing Transesophageal Echocardiography Before Pulmonary Vein Isolation. J. Am. Coll. Cardiol., November 24, 2009; 54(22): 2032 - 2039. [Abstract] [Full Text] [PDF]

				T. Terasawa, E. M. Balk, M. Chung, A. C. Garlitski, A. A. Alsheikh-Ali, J. Lau, and S. Ip Systematic Review: Comparative Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation Ann Intern Med, August 4, 2009; 151(3): 191 - 202. [Abstract] [Full Text] [PDF]

				M. A. Crandall, D. J. Bradley, D. L. Packer, and S. J. Asirvatham Contemporary Management of Atrial Fibrillation: Update on Anticoagulation and Invasive Management Strategies Mayo Clin. Proc., July 1, 2009; 84(7): 643 - 662. [Abstract] [Full Text] [PDF]

				H. Oral, A. Chugh, K. Yoshida, J. F. Sarrazin, M. Kuhne, T. Crawford, N. Chalfoun, D. Wells, W. Boonyapisit, S. Veerareddy, et al. A randomized assessment of the incremental role of ablation of complex fractionated atrial electrograms after antral pulmonary vein isolation for long-lasting persistent atrial fibrillation. J. Am. Coll. Cardiol., March 3, 2009; 53(9): 782 - 789. [Abstract] [Full Text] [PDF]

				C. Sticherling, O. Pfister, and S. Osswald Thrombo-embolic occlusion of the left anterior descending coronary artery complicating left atrial radiofrequency ablation Europace, January 1, 2009; 11(1): 117 - 118. [Abstract] [Full Text] [PDF]

				P. Jais, B. Cauchemez, L. Macle, E. Daoud, P. Khairy, R. Subbiah, M. Hocini, F. Extramiana, F. Sacher, P. Bordachar, et al. Catheter Ablation Versus Antiarrhythmic Drugs for Atrial Fibrillation: The A4 Study Circulation, December 9, 2008; 118(24): 2498 - 2505. [Abstract] [Full Text] [PDF]

				R. S. Gabriel and A. L. Klein Managing catheter ablation for atrial fibrillation: the role of echocardiography Europace, November 1, 2008; 10(suppl_3): iii8 - iii13. [Abstract] [Full Text] [PDF]

				E. Aliot and J. N. Ruskin Controversies in ablation of atrial fibrillation Eur. Heart J. Suppl., September 1, 2008; 10(suppl_H): H32 - H54. [Abstract] [Full Text] [PDF]

				H. Nakagawa, K. A. Seres, and W. M. Jackman Limitations of Esophageal Temperature-Monitoring to Prevent Esophageal Injury During Atrial Fibrillation Ablation Circ Arrhythm Electrophysiol, August 1, 2008; 1(3): 150 - 152. [Full Text] [PDF]

				J. J. Blanc, J. Almendral, M. Brignole, M. Fatemi, K. Gjesdal, E. Gonzalez-Torrecilla, P. Kulakowski, G. Y.H. Lip, D. Shah, C. Wolpert, et al. Consensus document on antithrombotic therapy in the setting of electrophysiological procedures Europace, May 1, 2008; 10(5): 513 - 527. [Full Text] [PDF]

				S. A Lubitz, A. Fischer, and V. Fuster Catheter ablation for atrial fibrillation BMJ, April 12, 2008; 336(7648): 819 - 826. [Full Text] [PDF]

				H. Oral, A. Chugh, E. Good, T. Crawford, J. F. Sarrazin, M. Kuhne, N. Chalfoun, D. Wells, W. Boonyapisit, N. Gadeela, et al. Randomized Evaluation of Right Atrial Ablation After Left Atrial Ablation of Complex Fractionated Atrial Electrograms for Long-Lasting Persistent Atrial Fibrillation Circ Arrhythm Electrophysiol, April 1, 2008; 1(1): 6 - 13. [Abstract] [Full Text] [PDF]

				K. Nademanee, M. C. Schwab, E. M. Kosar, M. Karwecki, M. D. Moran, N. Visessook, A. D. Michael, and T. Ngarmukos Clinical Outcomes of Catheter Substrate Ablation for High-Risk Patients With Atrial Fibrillation J. Am. Coll. Cardiol., February 26, 2008; 51(8): 843 - 849. [Abstract] [Full Text] [PDF]

				S. Weis, C. Piorkowski, A. Arya, and A. Bollmann Septic vegetation at the left atrial appendage entrance after pulmonary vein ablation for atrial fibrillation Europace, February 1, 2008; 10(2): 215 - 217. [Abstract] [Full Text] [PDF]

				O. M. Wazni, S. Beheiry, T. Fahmy, C. Barrett, S. Hao, D. Patel, L. Di Biase, D. O. Martin, M. Kanj, M. Arruda, et al. Atrial Fibrillation Ablation in Patients With Therapeutic International Normalized Ratio: Comparison of Strategies of Anticoagulation Management in the Periprocedural Period Circulation, November 27, 2007; 116(22): 2531 - 2534. [Abstract] [Full Text] [PDF]

				M. D. O'Neill, P. Jais, M. Hocini, F. Sacher, G. J. Klein, J. Clementy, and M. Haissaguerre Catheter Ablation for Atrial Fibrillation Circulation, September 25, 2007; 116(13): 1515 - 1523. [Full Text] [PDF]

				P. Jais and D. L. Packer Ablation vs. drug use for atrial fibrillation Eur. Heart J. Suppl., September 1, 2007; 9(suppl_G): G26 - G34. [Abstract] [Full Text] [PDF]

				H. Calkins, J. Brugada, D. L. Packer, R. Cappato, S.-A. Chen, H. J.G. Crijns, R. J. Damiano Jr, D. W. Davies, D. E. Haines, M. Haissaguerre, et al. HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation Developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and Approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society. Europace, June 1, 2007; 9(6): 335 - 379. [Full Text] [PDF]

				H. Oral, A. Chugh, E. Good, A. Wimmer, S. Dey, N. Gadeela, S. Sankaran, T. Crawford, J. F. Sarrazin, M. Kuhne, et al. Radiofrequency Catheter Ablation of Chronic Atrial Fibrillation Guided by Complex Electrograms Circulation, May 22, 2007; 115(20): 2606 - 2612. [Abstract] [Full Text] [PDF]