Catheter ablation for atrial fibrillation on uninterrupted warfarin: NEED it be done WITH echo guidance?

摘要

Pulmonary vein isolation has become the cornerstone of modern day ablation strategies for atrial fibrillation. While much has been debated regarding the best approach to improving efficacy, equally important discussions have centered on ways in which to mitigate periprocedural risk. It is estimated that approximately 5% of patients undergoing pulmonary vein isolation will experience a complication that either prolongs hospitalization or results in long-term disability.1 While bleeding may be the most common event, one of the most feared is the possibility of cerebrovascular accidents often occurring within the first 2 weeks after an ablation.2 There are several factors inherent in the procedure that may predispose patients to this phenomenon. First, the mere presence of catheters in the heart has been shown to be thrombogenic by activating the coagulation cascade.3 Second, radiofrequency ablation of the endocardial endothelium can disrupt natural anticoagulant processes and promote exposure of tissue factors that may attract thrombin-laden clot formation on the atrial endocardial surface.