Stroke and Bleeding Risks of Endocardial Ablation for Ventricular Arrhythmias (JCEP February 2024)-Article: Stroke and Bleeding Risks of Endocardial Ablation for Ventricular Arrhythmias

Article: Stroke and Bleeding Risks of Endocardial Ablation for Ventricular Arrhythmias

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A study assessed the risks of embolic and bleeding complications in relation to antithrombotic regimens before and after endocardial radiofrequency catheter ablation procedures for ventricular arrhythmias. The study included 663 procedures in 616 patients, with a median age of 64 years and 70.3% being male. The results showed a low incidence of embolic events, with 2 strokes (0.3% of procedures) and 1 transient ischemic attack (0.15%). There were 39 bleeding complications, including 11 pericardial effusions and 28 related to vascular access. Preprocedure use of non-aspirin antiplatelet agents and direct oral anticoagulants (DOACs) were associated with an increased risk of bleeding complications. Following ablation, 49.8% of patients were treated with aspirin 325 mg/day and 30.3% received DOACs or warfarin. The study concluded that stroke is a rare complication of catheter ablation for ventricular arrhythmias, and a tailored approach to antithrombotic therapy using aspirin 325 mg/day as a minimal postprocedure regimen is reasonable for most patients, with more potent regimens reserved for selected patients. The routine use of DOACs after ablation was not supported by the study data. The study highlights the need for individualized antithrombotic therapy based on the patient's risk profile. Further research is needed to inform precise antithrombotic regimens in patients undergoing ventricular arrhythmia ablation.

Keywords

embolic complications

bleeding complications

antithrombotic regimens

radiofrequency catheter ablation

ventricular arrhythmias

stroke incidence

pericardial effusions

vascular access complications

aspirin use

DOACs