P247Novel oral anticoagulants vs warfarin to prevent asymptomatic cerebral lesions during ablation of atrial fibrillation

Abstract

Background and Purpose: Performing left atrial (LA) radiofrequency ablation in treating atrial fibrillation (AF) has been associated with an increased risk of asymptomatic cerebral lesions (ACL). ACL's clinical consequences are unclear but some studies suggest that it can result in later cognitive decline. Uninterrupted oral anticoagulation (OAC) during AF ablation is recommended by recent guidelines to prevent thromboembolism. Non-vitamin-K novel oral anticoagulants (NOACs) were introduced for stroke prevention in AF and their efficacy and safety have been shown in several studies. Our aim was to compare the incidence of ACLs during AF ablation using either uninterrupted Vitamin-KAntagonists (VKAs) or NOACs. Pre- and post-procedural cerebral magnetic resonance imaging (MRI; diffusion weighted imaging) was used to assess ACLs. Methods and results: A total of 408 consecutive patients with paroxysmal or persistent atrial fibrillation (VKA n=304; NOAC n=104) scheduled for catheter ablation were included in the study. A significant difference in baseline parameters could be observed for LA diameter and CHADSVASc score. Patients in both groups had normal LVEF. During all procedures targeted activated clotting time (ACT; i.v. heparin) was between 300 and 400 seconds, but significantly higher in the VKA-group. LA procedure time and distribution of PVI-only-procedures (pulmonary vein isolation) were comparable (Tab 1). 29 (9.6%) patients in the VKA group and 18 (17.3%) patients on NOACs showed new ACLs in post-procedural cerebral MRI (p= 0.049, Fig.1). All-cause mortality, rate of stroke or need for cardiac surgery intervention did not occur in both groups. In patients with ACLs a significant difference in CHADSVASc, LA diameter and ACT could be observed. Conclusion: The use of VKAs during AF-ablation was associated with a significantly lower risk of post-ablation ACLs as compared to NOACs. Higher CHADSVASc score and greater LA diameter at baseline, further a lower ACT during procedures seem to be the clinical predictors of such events. (Figure Presented).