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.