Stroke and left atrial thrombi after cryoballoon ablation of atrial fibrillation: incidence and predictors. Results from a long-term follow-up

Francesco Santoro; Natale Daniele Brunetti; Andreas Rillig; Bruno Reissmann; Christine Lemeš; Tilman Maurer; Thomas Fink; Naotaka Hashiguchi; Alessandra Leopizzi; Adriana Mallardi; Shibu Mathew; Feifan Ouyang; Karl Heinz Kuck; Roland R. Tilz; Andreas Metzner; Christian H. Heeger

doi:10.1007/s11239-020-02148-x

Stroke and left atrial thrombi after cryoballoon ablation of atrial fibrillation: incidence and predictors. Results from a long-term follow-up

Francesco Santoro^*, Natale Daniele Brunetti, Andreas Rillig, Bruno Reissmann, Christine Lemeš, Tilman Maurer, Thomas Fink, Naotaka Hashiguchi, Alessandra Leopizzi, Adriana Mallardi, Shibu Mathew, Feifan Ouyang, Karl Heinz Kuck, Roland R. Tilz, Andreas Metzner, Christian H. Heeger

^*Corresponding author for this work

Department of Internal Medicine II

4 Citations (Scopus)

Abstract

Stroke after catheter ablation (CA) of atrial fibrillation (AF) is a potential complication with long term consequences. Aim of this study was to determine incidence and potential predictors of stroke and left atrial appendage (LAA) thrombi after AF ablation with cryo-energy. Two hundred nine consecutive patients with symptomatic drug refractory AF (65% male; 61 ± 11 yo, 69% paroxysmal AF, mean CHA₂DS₂-VASc score 2 ± 1.4) were enrolled between October 2012 until December 2015. Long term follow-up was performed with outpatient clinic visits at 6-month intervals. Incidence of stroke after CA was 1.4% (3/209 pts) at long term follow-up. Two out of 3 pts experienced stroke during the first 3 month after CA and one after 36 months. At long term follow-up LAA thrombi were found in two patients (1%) that were on therapeutic oral anticoagulation. Recurrence of AF was found in 4 out of 5 pts with stroke or LAA thrombi. Patients with stroke or LAA thrombi did not differed from those without in term of age, gender, CV risk factors, LA size and AF type. They differed only for EHRA score (2.4 vs 1.3, p = 0.01) before CA. At multivariate analysis after correction for age, gender, LA size, LVEF and AF type, only EHRA score (β 1.92, 95% C.I. 1.3–35 p = 0.02), was an independent predictor of stroke/LAA thrombi. Incidence of stroke after cryoablation is low, with a relative higher prevalence during the first 3 months after CA. Prospective, multicenter long-term registries are needed for a better stroke risk stratification.

Original language	English
Journal	Journal of Thrombosis and Thrombolysis
ISSN	0929-5305
DOIs	https://doi.org/10.1007/s11239-020-02148-x
Publication status	Published - 23.05.2020

Funding

CHH received travel grants and research grants by Medtronic, Claret Medical, SentreHeart, Biosense Webster and Cardiofocus. KHK received travel grants and research grants from Biosense Webster, Stereotaxis, Prorhythm, Medtronic, Edwards, Cryocath, and is a consultant to St. Jude Medical, Biosense Webster, Prorhythm, and Stereotaxis. He received speaker's honoraria from Medtronic. RRT received travel grants from St. Jude Medical, Topera, Biosense Webster, Daiichi Sankyo, SentreHeart and Speaker’s Bureau Honoraria from Biosense Webster, Biotronik, Pfizer, Topera, Bristol-Myers Squibb; Bayer, Sano Aventis and research grants by Cardiofocus. AM received speaker's honoraria and travel grants from Medtronic, Biosense Webster and Cardiofocus.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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Santoro, F., Brunetti, N. D., Rillig, A., Reissmann, B., Lemeš, C., Maurer, T., Fink, T., Hashiguchi, N., Leopizzi, A., Mallardi, A., Mathew, S., Ouyang, F., Kuck, K. H., Tilz, R. R., Metzner, A., & Heeger, C. H. (2020). Stroke and left atrial thrombi after cryoballoon ablation of atrial fibrillation: incidence and predictors. Results from a long-term follow-up. Journal of Thrombosis and Thrombolysis. https://doi.org/10.1007/s11239-020-02148-x

@article{2be79838b83949b398f7e8c130e89799,

title = "Stroke and left atrial thrombi after cryoballoon ablation of atrial fibrillation: incidence and predictors. Results from a long-term follow-up",

abstract = "Stroke after catheter ablation (CA) of atrial fibrillation (AF) is a potential complication with long term consequences. Aim of this study was to determine incidence and potential predictors of stroke and left atrial appendage (LAA) thrombi after AF ablation with cryo-energy. Two hundred nine consecutive patients with symptomatic drug refractory AF (65\% male; 61 ± 11 yo, 69\% paroxysmal AF, mean CHA2DS2-VASc score 2 ± 1.4) were enrolled between October 2012 until December 2015. Long term follow-up was performed with outpatient clinic visits at 6-month intervals. Incidence of stroke after CA was 1.4\% (3/209 pts) at long term follow-up. Two out of 3 pts experienced stroke during the first 3 month after CA and one after 36 months. At long term follow-up LAA thrombi were found in two patients (1\%) that were on therapeutic oral anticoagulation. Recurrence of AF was found in 4 out of 5 pts with stroke or LAA thrombi. Patients with stroke or LAA thrombi did not differed from those without in term of age, gender, CV risk factors, LA size and AF type. They differed only for EHRA score (2.4 vs 1.3, p = 0.01) before CA. At multivariate analysis after correction for age, gender, LA size, LVEF and AF type, only EHRA score (β 1.92, 95\% C.I. 1.3–35 p = 0.02), was an independent predictor of stroke/LAA thrombi. Incidence of stroke after cryoablation is low, with a relative higher prevalence during the first 3 months after CA. Prospective, multicenter long-term registries are needed for a better stroke risk stratification.",

author = "Francesco Santoro and Brunetti, \{Natale Daniele\} and Andreas Rillig and Bruno Reissmann and Christine Leme{\v s} and Tilman Maurer and Thomas Fink and Naotaka Hashiguchi and Alessandra Leopizzi and Adriana Mallardi and Shibu Mathew and Feifan Ouyang and Kuck, \{Karl Heinz\} and Tilz, \{Roland R.\} and Andreas Metzner and Heeger, \{Christian H.\}",

note = "Funding Information: CHH received travel grants and research grants by Medtronic, Claret Medical, SentreHeart, Biosense Webster and Cardiofocus. KHK received travel grants and research grants from Biosense Webster, Stereotaxis, Prorhythm, Medtronic, Edwards, Cryocath, and is a consultant to St. Jude Medical, Biosense Webster, Prorhythm, and Stereotaxis. He received speaker's honoraria from Medtronic. RRT received travel grants from St. Jude Medical, Topera, Biosense Webster, Daiichi Sankyo, SentreHeart and Speaker{\textquoteright}s Bureau Honoraria from Biosense Webster, Biotronik, Pfizer, Topera, Bristol-Myers Squibb; Bayer, Sano Aventis and research grants by Cardiofocus. AM received speaker's honoraria and travel grants from Medtronic, Biosense Webster and Cardiofocus. Publisher Copyright: {\textcopyright} 2020, Springer Science+Business Media, LLC, part of Springer Nature. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.",

year = "2020",

month = may,

day = "23",

doi = "10.1007/s11239-020-02148-x",

language = "English",

journal = "Journal of Thrombosis and Thrombolysis",

issn = "0929-5305",

publisher = "Springer",

}

Santoro, F, Brunetti, ND, Rillig, A, Reissmann, B, Lemeš, C, Maurer, T, Fink, T, Hashiguchi, N, Leopizzi, A, Mallardi, A, Mathew, S, Ouyang, F, Kuck, KH, Tilz, RR, Metzner, A & Heeger, CH 2020, 'Stroke and left atrial thrombi after cryoballoon ablation of atrial fibrillation: incidence and predictors. Results from a long-term follow-up', Journal of Thrombosis and Thrombolysis. https://doi.org/10.1007/s11239-020-02148-x

TY - JOUR

T1 - Stroke and left atrial thrombi after cryoballoon ablation of atrial fibrillation: incidence and predictors. Results from a long-term follow-up

AU - Santoro, Francesco

AU - Brunetti, Natale Daniele

AU - Rillig, Andreas

AU - Reissmann, Bruno

AU - Lemeš, Christine

AU - Maurer, Tilman

AU - Fink, Thomas

AU - Hashiguchi, Naotaka

AU - Leopizzi, Alessandra

AU - Mallardi, Adriana

AU - Mathew, Shibu

AU - Ouyang, Feifan

AU - Kuck, Karl Heinz

AU - Tilz, Roland R.

AU - Metzner, Andreas

AU - Heeger, Christian H.

N1 - Funding Information: CHH received travel grants and research grants by Medtronic, Claret Medical, SentreHeart, Biosense Webster and Cardiofocus. KHK received travel grants and research grants from Biosense Webster, Stereotaxis, Prorhythm, Medtronic, Edwards, Cryocath, and is a consultant to St. Jude Medical, Biosense Webster, Prorhythm, and Stereotaxis. He received speaker's honoraria from Medtronic. RRT received travel grants from St. Jude Medical, Topera, Biosense Webster, Daiichi Sankyo, SentreHeart and Speaker’s Bureau Honoraria from Biosense Webster, Biotronik, Pfizer, Topera, Bristol-Myers Squibb; Bayer, Sano Aventis and research grants by Cardiofocus. AM received speaker's honoraria and travel grants from Medtronic, Biosense Webster and Cardiofocus. Publisher Copyright: © 2020, Springer Science+Business Media, LLC, part of Springer Nature. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.

PY - 2020/5/23

Y1 - 2020/5/23

N2 - Stroke after catheter ablation (CA) of atrial fibrillation (AF) is a potential complication with long term consequences. Aim of this study was to determine incidence and potential predictors of stroke and left atrial appendage (LAA) thrombi after AF ablation with cryo-energy. Two hundred nine consecutive patients with symptomatic drug refractory AF (65% male; 61 ± 11 yo, 69% paroxysmal AF, mean CHA2DS2-VASc score 2 ± 1.4) were enrolled between October 2012 until December 2015. Long term follow-up was performed with outpatient clinic visits at 6-month intervals. Incidence of stroke after CA was 1.4% (3/209 pts) at long term follow-up. Two out of 3 pts experienced stroke during the first 3 month after CA and one after 36 months. At long term follow-up LAA thrombi were found in two patients (1%) that were on therapeutic oral anticoagulation. Recurrence of AF was found in 4 out of 5 pts with stroke or LAA thrombi. Patients with stroke or LAA thrombi did not differed from those without in term of age, gender, CV risk factors, LA size and AF type. They differed only for EHRA score (2.4 vs 1.3, p = 0.01) before CA. At multivariate analysis after correction for age, gender, LA size, LVEF and AF type, only EHRA score (β 1.92, 95% C.I. 1.3–35 p = 0.02), was an independent predictor of stroke/LAA thrombi. Incidence of stroke after cryoablation is low, with a relative higher prevalence during the first 3 months after CA. Prospective, multicenter long-term registries are needed for a better stroke risk stratification.

AB - Stroke after catheter ablation (CA) of atrial fibrillation (AF) is a potential complication with long term consequences. Aim of this study was to determine incidence and potential predictors of stroke and left atrial appendage (LAA) thrombi after AF ablation with cryo-energy. Two hundred nine consecutive patients with symptomatic drug refractory AF (65% male; 61 ± 11 yo, 69% paroxysmal AF, mean CHA2DS2-VASc score 2 ± 1.4) were enrolled between October 2012 until December 2015. Long term follow-up was performed with outpatient clinic visits at 6-month intervals. Incidence of stroke after CA was 1.4% (3/209 pts) at long term follow-up. Two out of 3 pts experienced stroke during the first 3 month after CA and one after 36 months. At long term follow-up LAA thrombi were found in two patients (1%) that were on therapeutic oral anticoagulation. Recurrence of AF was found in 4 out of 5 pts with stroke or LAA thrombi. Patients with stroke or LAA thrombi did not differed from those without in term of age, gender, CV risk factors, LA size and AF type. They differed only for EHRA score (2.4 vs 1.3, p = 0.01) before CA. At multivariate analysis after correction for age, gender, LA size, LVEF and AF type, only EHRA score (β 1.92, 95% C.I. 1.3–35 p = 0.02), was an independent predictor of stroke/LAA thrombi. Incidence of stroke after cryoablation is low, with a relative higher prevalence during the first 3 months after CA. Prospective, multicenter long-term registries are needed for a better stroke risk stratification.

UR - https://www.scopus.com/pages/publications/85084996549

U2 - 10.1007/s11239-020-02148-x

DO - 10.1007/s11239-020-02148-x

M3 - Journal articles

AN - SCOPUS:85084996549

SN - 0929-5305

JO - Journal of Thrombosis and Thrombolysis

JF - Journal of Thrombosis and Thrombolysis

ER -

Stroke and left atrial thrombi after cryoballoon ablation of atrial fibrillation: incidence and predictors. Results from a long-term follow-up

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