Safety of catheter ablation for atrial fibrillation in patients with intracranial hemorrhage

Abstract

The safety of anticoagulation and radiofrequency catheter ablation (RFCA) in patients with atrial fibrillation (AF) and ahistory of intracranial hemorrhage (ICH) remains unclear. We investigated the risks and benefits of this approach in AF patients with ahistory of ICH. The ICH group included 45AF patients with ahistory of ICH who underwent RFCA. Five of these patients were excluded because ICH occurred spontaneously after cerebral infarction. The control group included 80individuals who presented for AF ablation and did not have ahistory of ICH. Two controls were matched for each study group patient in terms of sex, age (±2years), type of AF, and procedure date. Patients in the ICH group had higher CHADS2 (1.7± 1.3 vs. 1.1± 1.2, p< 0.05), CHA2DS2-VASc (2.6± 1.7 vs. 1.9± 1.6, p< 0.05), and HAS-BLED scores (2.5± 1.0 vs. 1.1± 1.0, p< 0.001). All participants in both groups underwent successful RFCA. The incidence of ICH during follow-up (1 vs. 0, p= 0.333) was similar between the ICH and control groups. AF-free survival between the two groups was not significant (log-rank p= 0.283) within the first 3months, but was significant (log-rank p= 0.011) within 48months of RFCA. History of ICH was the only independent predictor of AF recurrence according to univariate Cox regression analysis. In AF patients with a history of ICH, AF ablation with astandard anticoagulation strategy is safe and does not seem to be associated with an increased risk of hemorrhage.