Does catheter ablation for atrial fibrillation increase or reduce neurological insult?
- 1 January 2012
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Current Opinion in Cardiology
- Vol. 27 (1), 36-40
- https://doi.org/10.1097/hco.0b013e32834d846a
Abstract
This article will review the periprocedural and long-term risk of stroke and other adverse neurological outcomes in patients having catheter ablation of atrial fibrillation. Randomized trials of medication-based rhythm control for atrial fibrillation have failed to demonstrate a reduction in stroke. There is hope that catheter ablation of atrial fibrillation may provide such a benefit; however, definitive clinical trials have yet to be completed. It is well established that catheter ablation of atrial fibrillation is associated with a risk of periprocedural stroke; however, new studies using magnetic resonance imaging suggest that silent cerebral infarction is 10 times more common than clinical stroke. Studies which have systematically screened for silent cerebral infarction have been invaluable in refining the technique of atrial fibrillation catheter ablation, by identifying procedural details and ablation technologies which are more likely to result in this surrogate outcome. There is also early suggestion that these silent infarctions may be associated with longer-term adverse neuropsychological outcomes. A more precise understanding of neurological injury with catheter ablation of atrial fibrillation is helping to refine this technique and will ultimately help determine if the prevention of recurrent atrial fibrillation with catheter ablation can reduce the risk of stroke.Keywords
This publication has 42 references indexed in Scilit:
- Dabigatran versus Warfarin in Patients with Atrial FibrillationNew England Journal of Medicine, 2009
- Meta-analysis: Antithrombotic Therapy to Prevent Stroke in Patients Who Have Nonvalvular Atrial FibrillationAnnals of Internal Medicine, 2007
- Lifetime Risk for Development of Atrial FibrillationCirculation, 2004
- Antithrombotic Therapy To Prevent Stroke in Patients with Atrial FibrillationAnnals of Internal Medicine, 1999
- Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high-risk patients with atrial fibrillation: Stroke Prevention in Atrial Fibrillation III randomised clinical trialThe Lancet, 1996
- The natural history of atrial fibrillation: Incidence, risk factors, and prognosis in the manitoba follow-up studyAmerican Journal Of Medicine, 1995
- Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study)The American Journal of Cardiology, 1994
- Atrial fibrillation as an independent risk factor for stroke: the Framingham Study.Stroke, 1991
- Atrial Fibrillation: A Major Contributor to Stroke in the ElderlyArchives of Internal Medicine, 1987
- Epidemiologic assessment of chronic atrial fibrillation and risk of strokeNeurology, 1978