Abstract:

Background: Risks of radiofrequency catheter ablation (RFA) for ventricular arrhythmias (VA) include emboli and bleeding complications but data on antithrombotic regimens are limited and guidelines do not specify a systematic approach.

Objective: To assess embolic and bleeding complications in relation to pre and post-peri procedure antithrombotic regimens.

Methods: Prospective assessment for complications was performed for 663 endocardial RFA procedures in 616 consecutive patients (median age 64 years [IQR 54-73], 70.3% men, 71.6% cardiomyopathy, 44.5% sustained VT).

Results: There were 2 strokes [0.3% (95% CI:[0.0%, 0.8%])], one transient ischemic attack (0.15%), and 2 pulmonary emboli (0.3%). There were 39 (5.9%) bleeding complications including 11 (1.7%) pericardial effusions and 28 (4.2%) related to vascular access.

Consistent with the prevalence of coronary artery disease (47.5%), atrial fibrillation (30.0%), and prior stroke (10.6%), pre-procedure 464 (70.0%) patients were taking antithrombotic agents; including 220 (33.2%) taking aspirin alone (ASA), and 163 (24.6%) taking warfarin or a direct acting oral anticoagulant (DOCA). Pre-procedure non-ASA antiplatelet use (OR:2.846, P= 0.011) and DOAC use (OR:2.585, P= 0.032) were associated with risk of bleeding complications. Following ablation 49.8% of patients were treated with ASA 325 mg/daily, and 30.3% received DOACs or warfarin. New DOAC or warfarin administration was initiated in only 6.6% of patients. Overall 39.7% of patients continued the same pre-procedure antithrombotic regimen.

Conclusion: Stroke is a rare complication of RFA for VA using ASA 325 mg/daily as a minimal post-procedure regimen with more potent regimens for selected patients

Editor-in-Chief
Kalyanam Shivkumar, MD, PhD, FACC
 
CME Editor
Kenneth A. Ellenbogen, MD, FACC

Author
Kelvin Bush, MD 

Important Dates
Date of Release: February 26, 2024
Term of Approval/Date of CME/MOC Expiration: February 25, 2025