Introduction
Catheter ablation is a common intervention for atrial fibrillation (AF) but there are concerns about serious complications, with clinically apparent cerebral thromboembolisms being the most worrisome. Although the incidence of cerebral thromboembolisms is very low (<1%),1 recent studies suggest that they are only the tip of the iceberg.2,3
A silent cerebral event (SCE) is defined as an acute new brain lesion in a patient without clinically apparent neurological deficit. SCEs are detected by brain magnetic resonance imaging (MRI). The lesions are usually small, but typical to cerebral thromboembolisms; they are frequently observed in asymptomatic patients who have undergone AF ablation. Although the small number of SCEs does not cause neurocognitive dysfunction, the greater volume and/or larger number of SCE lesions are reportedly related to neuropsychological decline.4 SCE incidence may be a surrogate marker for the potential thromboembolic risk under specific ablation procedure and peri-procedural OAC. Thus, strategies to reduce SCE might be beneficial.
The uninterrupted use of non-vitamin K antagonist oral anticoagulants (NOACs) became the practical standard for the peri-procedural OAC and reportedly reduced the risk of SCEs when compared to the use with interruption during the procedure.4 However, a recent meta-analysis demonstrated that the incidence of SCEs remains at around 16% even in the uninterrupted OAC.5 Exploring the risk factors of SCEs may contribute to further reduction of potential thromboembolic risk in the era of uninterrupted OAC for AF ablation.
Therefore, we sought factors associated with SCEs during AF ablation in patients on uninterrupted OAC for the peri-procedural period.