Early cerebral thromboembolic complications after radiofrequency catheter ablation of atrial fibrillation: incidence, characteristics, and risk factors
Abstract
Background Thromboembolic complications remain one of the most severe adverse events associated with catheter ablation of atrial fibrillation (AF), but data on such events are limited.Objective The purpose of this study was to evaluate the incidence, characteristics, and risk factors of thromboembolic complications after AF ablation.Methods Cerebral thromboembolic complications occurring within 1 month of 3360 consecutive AF radiofrequency catheter ablations were assessed. Stroke was defined as a neurologic deficit lasting more than 24 hours or with imaging study showing new infarction. Transient ischemic attack (TIA) was defined as a deficit lasting less than 24 hours and without documented infarction.Results There were 17 peri-interventional cerebral thromboembolic events (0.5%). Nine cases (53%) were diagnosed as strokes and 8 (47%) as TIAs. Sixty percent of the events occurred within 48 hours after the ablation; the rest occurred within 1 week. In univariate analysis, peri-interventional thromboembolism was associated with peripheral vascular disease (P = .010), impaired left ventricular ejection fraction (P = .040), periprocedural bridging with heparin (P = .007), and previous stroke (P = .026). Multivariable analysis demonstrated that peripheral vascular disease (odds ratio [OR] 8.81, confidence interval [CI] 1.61-48.31, P = .012) and previous stroke (OR 6.13, CI 1.18-31.91, P = .031) were independent predictors. In a different model, the CHA2DS2-VASc score was associated with thromboembolism (OR 1.35, CI 1.00-1.80, P = .049).Conclusion Cerebral thromboembolic complications after AF radiofrequency catheter ablation are rare. They mostly occur within 48 hours after the procedure and remain without lasting neurologic deficits in the majority of cases. Such complications are associated with peripheral vascular disease, previous stroke, and the CHA2DS2-VASc score.
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Post-procedure complications of catheter ablation include stroke with the highest risk within the first week, late pericardial tamponade several days after catheter ablation, and oesophageal fistulas usually apparent 7-30 days after ablation.
“Post-procedure complications include stroke, with the highest risk within the first week, 753 late pericardial tamponade several days after catheter ablation, 751 and oesophageal fistulas, which usually become apparent 7-30 days after ablation.”
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- Authors
- Kosiuk, J., Kornej, J., Bollmann, A., Piorkowski, C., Myrda, K., Arya, A., Sommer, P., Richter, S., Rolf, S., Husser, D., Gaspar, T., Lip, G. Y. H., & Hindricks, G.
- Affiliations
- Birmingham City Hospital (GB)
- Leipzig Heart Institute (DE)
- Herzzentrum Dresden Universitätsklinik (DE)
- Silesian Center for Heart Disease (PL)
- ORCID
- Venue
- Heart Rhythm
- Publisher
- Elsevier BV
- Published
- 2014-11
- Volume
- 11
- Issue
- 11
- Pages
- 1934-1940
- ISSN
- 1547-5271 (ISSN-L)
- OpenAlex
- W2141317705
- Cited by
- 36
- References
- 23
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 8 · 2023: 5 · 2020: 1 · 2017: 9 · 2016: 4 · 2015: 3 · 2014: 1
- FWCI
- 3.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Heart Rhythm (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- atrial fibrillation, radiofrequency catheter ablation, cerebral thromboembolism, stroke, transient ischemic attack, risk factors, peripheral vascular disease, stroke history, CHA2DS2-VASc score, left ventricular ejection fraction, heparin bridging
- MeSH terms
- Atrial Fibrillation, Female, Humans, Male, Middle Aged, Postoperative Complications, Risk Factors, Incidence, Catheter Ablation, International Normalized Ratio, Intracranial Thrombosis
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