Importance of anticoagulation and postablation silent cerebral lesions: Subanalyses of REVOLUTION and reMARQable studies

Massimo Grimaldi, Vijay Swarup, Brian DeVille, Jonathan Sussman, Pierre Jaïs, Fiorenzo Gaita, Mattias Duytschaever, G. Andre Ng, Emile Daoud, Dhanunjaya D.J. Lakkireddy, Rodney Horton, Andrew Wickliffe, Christopher Ellis, L. Gellér

Research output: Contribution to journalArticle

Abstract

Background: Silent cerebral lesions (SCLs) are a potential complication of left atrial radiofrequency ablation (RFA) procedures for paroxysmal atrial fibrillation (PAF). We aimed to compare the incidence of SCLs in patients treated with irrigated RFA multielectrode catheters (nMARQ® Catheter group) and irrigated focal RFA catheters (NAVISTAR® THERMOCOOL® Catheter; TC group) after PAF ablation from subpopulation neurological assessment (SNA) cohorts of the REVOLUTION and reMARQable studies. Methods: Data from SNA cohorts in the prospective, nonrandomized REVOLUTION study (March 2011–September 2013) and the prospective, randomized, controlled reMARQable study (October 2013–November 2015) were included. The incidence of SCLs was assessed pre- and postablation using magnetic resonance imaging. Neurological deficits were assessed using the National Institutes of Health Stroke Scale, modified Rankin Scale, and Montreal Cognitive Assessment. Results: A total of 37 patients from REVOLUTION and 76 patients from reMARQable were included in the SNA cohort of each study. In the REVOLUTION SNA cohort, the incidence of SCLs was 21.1% (4/19) in the nMARQ® Catheter group and 5.9% (1/17) in the TC group. Findings from REVOLUTION helped inform the reMARQable study protocol's stringent anticoagulation regimen. SCL incidence was subsequently reduced in both groups (nMARQ® Catheter, 7.9%; TC, 3.3%). No permanent neurological deficits were observed. Conclusion: Adherence to a stringent anticoagulation regimen prior to and during ablation procedures appears to be an important factor in minimizing the risk of SCL.

Original languageEnglish
Pages (from-to)1432-1439
Number of pages8
JournalPACE - Pacing and Clinical Electrophysiology
Volume40
Issue number12
DOIs
Publication statusPublished - Dec 1 2017

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Catheters
Catheter Ablation
Incidence
Atrial Fibrillation
National Institutes of Health (U.S.)
Cohort Studies
Stroke
Magnetic Resonance Imaging

Keywords

  • anticoagulation
  • atrial fibrillation
  • focal radiofrequency ablation catheter
  • multielectrode catheter
  • silent cerebral lesion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Importance of anticoagulation and postablation silent cerebral lesions : Subanalyses of REVOLUTION and reMARQable studies. / Grimaldi, Massimo; Swarup, Vijay; DeVille, Brian; Sussman, Jonathan; Jaïs, Pierre; Gaita, Fiorenzo; Duytschaever, Mattias; Ng, G. Andre; Daoud, Emile; Lakkireddy, Dhanunjaya D.J.; Horton, Rodney; Wickliffe, Andrew; Ellis, Christopher; Gellér, L.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 40, No. 12, 01.12.2017, p. 1432-1439.

Research output: Contribution to journalArticle

Grimaldi, M, Swarup, V, DeVille, B, Sussman, J, Jaïs, P, Gaita, F, Duytschaever, M, Ng, GA, Daoud, E, Lakkireddy, DDJ, Horton, R, Wickliffe, A, Ellis, C & Gellér, L 2017, 'Importance of anticoagulation and postablation silent cerebral lesions: Subanalyses of REVOLUTION and reMARQable studies', PACE - Pacing and Clinical Electrophysiology, vol. 40, no. 12, pp. 1432-1439. https://doi.org/10.1111/pace.13205
Grimaldi, Massimo ; Swarup, Vijay ; DeVille, Brian ; Sussman, Jonathan ; Jaïs, Pierre ; Gaita, Fiorenzo ; Duytschaever, Mattias ; Ng, G. Andre ; Daoud, Emile ; Lakkireddy, Dhanunjaya D.J. ; Horton, Rodney ; Wickliffe, Andrew ; Ellis, Christopher ; Gellér, L. / Importance of anticoagulation and postablation silent cerebral lesions : Subanalyses of REVOLUTION and reMARQable studies. In: PACE - Pacing and Clinical Electrophysiology. 2017 ; Vol. 40, No. 12. pp. 1432-1439.
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abstract = "Background: Silent cerebral lesions (SCLs) are a potential complication of left atrial radiofrequency ablation (RFA) procedures for paroxysmal atrial fibrillation (PAF). We aimed to compare the incidence of SCLs in patients treated with irrigated RFA multielectrode catheters (nMARQ{\circledR} Catheter group) and irrigated focal RFA catheters (NAVISTAR{\circledR} THERMOCOOL{\circledR} Catheter; TC group) after PAF ablation from subpopulation neurological assessment (SNA) cohorts of the REVOLUTION and reMARQable studies. Methods: Data from SNA cohorts in the prospective, nonrandomized REVOLUTION study (March 2011–September 2013) and the prospective, randomized, controlled reMARQable study (October 2013–November 2015) were included. The incidence of SCLs was assessed pre- and postablation using magnetic resonance imaging. Neurological deficits were assessed using the National Institutes of Health Stroke Scale, modified Rankin Scale, and Montreal Cognitive Assessment. Results: A total of 37 patients from REVOLUTION and 76 patients from reMARQable were included in the SNA cohort of each study. In the REVOLUTION SNA cohort, the incidence of SCLs was 21.1{\%} (4/19) in the nMARQ{\circledR} Catheter group and 5.9{\%} (1/17) in the TC group. Findings from REVOLUTION helped inform the reMARQable study protocol's stringent anticoagulation regimen. SCL incidence was subsequently reduced in both groups (nMARQ{\circledR} Catheter, 7.9{\%}; TC, 3.3{\%}). No permanent neurological deficits were observed. Conclusion: Adherence to a stringent anticoagulation regimen prior to and during ablation procedures appears to be an important factor in minimizing the risk of SCL.",
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T1 - Importance of anticoagulation and postablation silent cerebral lesions

T2 - Subanalyses of REVOLUTION and reMARQable studies

AU - Grimaldi, Massimo

AU - Swarup, Vijay

AU - DeVille, Brian

AU - Sussman, Jonathan

AU - Jaïs, Pierre

AU - Gaita, Fiorenzo

AU - Duytschaever, Mattias

AU - Ng, G. Andre

AU - Daoud, Emile

AU - Lakkireddy, Dhanunjaya D.J.

AU - Horton, Rodney

AU - Wickliffe, Andrew

AU - Ellis, Christopher

AU - Gellér, L.

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background: Silent cerebral lesions (SCLs) are a potential complication of left atrial radiofrequency ablation (RFA) procedures for paroxysmal atrial fibrillation (PAF). We aimed to compare the incidence of SCLs in patients treated with irrigated RFA multielectrode catheters (nMARQ® Catheter group) and irrigated focal RFA catheters (NAVISTAR® THERMOCOOL® Catheter; TC group) after PAF ablation from subpopulation neurological assessment (SNA) cohorts of the REVOLUTION and reMARQable studies. Methods: Data from SNA cohorts in the prospective, nonrandomized REVOLUTION study (March 2011–September 2013) and the prospective, randomized, controlled reMARQable study (October 2013–November 2015) were included. The incidence of SCLs was assessed pre- and postablation using magnetic resonance imaging. Neurological deficits were assessed using the National Institutes of Health Stroke Scale, modified Rankin Scale, and Montreal Cognitive Assessment. Results: A total of 37 patients from REVOLUTION and 76 patients from reMARQable were included in the SNA cohort of each study. In the REVOLUTION SNA cohort, the incidence of SCLs was 21.1% (4/19) in the nMARQ® Catheter group and 5.9% (1/17) in the TC group. Findings from REVOLUTION helped inform the reMARQable study protocol's stringent anticoagulation regimen. SCL incidence was subsequently reduced in both groups (nMARQ® Catheter, 7.9%; TC, 3.3%). No permanent neurological deficits were observed. Conclusion: Adherence to a stringent anticoagulation regimen prior to and during ablation procedures appears to be an important factor in minimizing the risk of SCL.

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KW - anticoagulation

KW - atrial fibrillation

KW - focal radiofrequency ablation catheter

KW - multielectrode catheter

KW - silent cerebral lesion

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