Role of anticoagulation therapy after pulmonary vein antrum isolation for atrial fibrillation treatment
| Autor: | Bruno De Piccoli, Antonio Raviele, Giuseppe Riccio, Antonio Rossillo, Sakis Themistoclakis, Aldo Bonso, Andrea Corrado, Michela Madalosso |
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| Rok vydání: | 2008 |
| Předmět: |
Male
medicine.medical_specialty Heart disease Intracardiac injection Pulmonary vein Risk Factors Internal medicine Atrial Fibrillation Medicine Humans Pulmonary vein stenosis Infusions Intravenous Stroke Retrospective Studies Ejection fraction Dose-Response Relationship Drug business.industry Heparin Incidence Anticoagulants Atrial fibrillation Retrospective cohort study General Medicine Middle Aged medicine.disease Treatment Outcome Pulmonary Veins Cardiology Catheter Ablation Female Cardiology and Cardiovascular Medicine business Echocardiography Transesophageal Follow-Up Studies |
| Zdroj: | Journal of cardiovascular medicine (Hagerstown, Md.). 9(1) |
| ISSN: | 1558-2027 |
| Popis: | Background Atrial fibrillation (AF) increases the risk of atrioembolic stroke. However, the role of anticoagulation therapy (OAT) in preventing cerebrovascular accidents (CVA) after intracardiac echocardiography-guided pulmonary vein antrum isolation (ICE-PVAI) is still unclear. In the present study, we evaluated the incidence of CVA following the interruption of OAT 3 months after ICE-PVAI. Methods Between September 2002 and March 2004, 85 consecutive patients (72 men, mean age 62 +/- 7 years) underwent ICE-PVAI for symptomatic drug-refractory AF. Heart disease was present in 61 patients (72%) (left ventricular ejection fraction = 58 +/- 6%, LA diameter 44 +/- 6 mm). Eighty-five consecutive patients who underwent electrical cardioversion (EC) for AF, matched for age, sex and heart disease, served as a control group. After 3 months, OAT was stopped unless one of the following conditions was observed: (i) AF-recurrence; (ii) severe pulmonary vein stenosis; (iii) non-good atrial contractility on transesophageal echocardiography; or (iv) other indications for OAT. Results In the study group, OAT was stopped after 3 months in 77 patients (90%) and no CVA occurred during the remaining follow-up (15 +/- 7 months). In the control group, 1 month after EC, OAT was stopped by the referring physician in 29 patients (34%). A stroke occurred in five patients (6%) (P = 0.09; mean P = 0.059) during follow-up. In two of these (2%), the stroke was fatal. Conclusions Stopping OAT 3 months after ICE-PVAI seems to be safe in patients without AF recurrences after the first 3 months following ablation. Further randomized-controlled studies are needed to confirm these preliminary data. |
| Databáze: | OpenAIRE |
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