• Luigi Di Biase, Fiorenzo Gaita, Elisabetta Toso, Pasquale Santangeli, Prasant Mohanty, Neal Rutledge, Xue Yan, Sanghamitra Mohanty, Chintan Trivedi, Rong Bai, Justin Price, Rodney Horton, G Joseph Gallinghouse, Salwa Beheiry, Jason Zagrodzky, Robert Canby, Jean François Leclercq, Franck Halimi, Marco Scaglione, Federico Cesarani, Riccardo Faletti, Javier Sanchez, J David Burkhardt, and Andrea Natale.
• Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Albert Einstein College of Medicine at Montefiore Hospital, New York, New York; Department of Biomedical Engineering, University of Texas, Austin, Texas; Department of Cardiology, University of Foggia, Foggia, Italy.
• Heart Rhythm. 2014 May 1;11(5):791-8.

BackgroundSilent cerebral ischemia (SCI) has been reported in 14% of cases after catheter ablation of atrial fibrillation (AF) with radiofrequency (RF) energy and discontinuation of warfarin before AF ablation procedures.ObjectiveThe purpose of this study was to determine whether periprocedural anticoagulation management affects the incidence of SCI after RF ablation using an open irrigated catheter.MethodsConsecutive patients undergoing RF ablation for AF without warfarin discontinuation and receiving heparin bolus before transseptal catheterization (group I, n = 146) were compared with a group of patients who had protocol deviation in terms of maintaining the therapeutic preprocedural international normalized ratio (patients with subtherapeutic INR) and/or failure to receive pretransseptal heparin bolus infusion and/or ≥2 consecutive ACT measurements <300 seconds (noncompliant population, group II, n = 134) and with a group of patients undergoing RF ablation with warfarin discontinuation bridged with low molecular weight heparin (group III, n = 148). All patients underwent preablation and postablation (within 48 hours) diffusion magnetic resonance imaging.ResultsSCI was detected in 2% of patients (3/146) in group I, 7% (10/134) in group II, and 14% (21/148) in group III (P <.001). "Therapeutic INR" was strongly associated with a lower prevalence of postprocedural silent cerebral ischemia (SCI). Multivariable analysis demonstrated nonparoxysmal AF (odds ratio 3.8, 95% confidence interval 1.5-9.7, P = .005) and noncompliance to protocol (odds ratio 2.8, 95% confidence interval 1.5-5.1, P <.001] to be significant predictors of ischemic events.ConclusionStrict adherence to an anticoagulation protocol significantly reduces the prevalence of SCI after catheter ablation of AF with RF energy.Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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