• Daniel Scherr, Kavita Sharma, Darshan Dalal, David Spragg, Karuna Chilukuri, Alan Cheng, Jun Dong, Charles A Henrikson, Saman Nazarian, Ronald D Berger, Hugh Calkins, and Joseph E Marine.
• Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
• J. Cardiovasc. Electrophysiol. 2009 Dec 1; 20 (12): 1357-63.

BackgroundCerebrovascular accident (CVA) is a serious complication of catheter ablation of atrial fibrillation (AF). The incidence and clinical predictors of periprocedural CVA in patients undergoing AF ablation are not fully understood.MethodsThis study included 721 cases (age 57 +/- 11 years; 23% female; 345 persistent AF) in 579 consecutive patients referred for AF ablation. Periprocedural CVA was defined as onset of a new neurologic deficit that occurred anytime between the start of the procedure and 30 days after the AF ablation, and was confirmed by a neurologist. Cranial imaging with CT and/or MRI was performed in each case. Patients were anticoagulated with warfarin for at least 4 weeks pre- and immediately postprocedure and were bridged with enoxaparin. Transesophageal echocardiography was performed within 24 hours prior to ablation in all cases.ResultsPeriprocedural CVA occurred in 10 of 721 cases (1.4%). The risk of periprocedural CVA did not vary significantly during the course of the study. Among these 10 patients (age 62 +/- 11 years; 1 female; 5 persistent AF), 6 manifested neurological deficits within 24 hours, 3 after 24-48 hours, and 1 patient had a CVA 6 days following AF ablation despite a therapeutic INR level. All CVAs were ischemic. Five patients had residual deficits after 30 days. Four of 43 patients (9.3%) with a prior history of CVA had periprocedural CVA. Periprocedural CVA occurred in 0.3%, 1.0%, and 4.7% of patients with CHADS(2) scores of 0, 1, and > or = 2 (P < 0.001). In 2 separate multivariate analyses, a CHADS(2) score > or = 2 (OR 7.1, P = 0.02) and history of CVA (OR 9.5, P < 0.01) remained independent predictors of periprocedural CVA.ConclusionsDespite periprocedural anticoagulation and transesophageal echocardiography, we found a 1.4% incidence of periprocedural CVA in AF ablation patients. A CHADS(2) score > or = 2 and a history of CVA are independent predictors of CVA after AF ablation. The CVA risk is low in patients with CHADS(2) score of 0.

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