Periprocedural stroke risk in patients undergoing catheter ablation for atrial fibrillation

[jedimasterlincoln]

Does anyone know/can find the risk of stroke immediately post ablation in those patients on anticoagulation and certain CHADS2 scores?

[Hidden]

Well, no idea except the younger you are the less likely a stroke would be.

[jedimasterlincoln in reply to Hidden]

I know that often the days immediately post ablation are supposed to be more likely, but it diminishes over time just wondered where/what this information was.

[Hidden in reply to jedimasterlincoln]

You can have too much information!

[wilsond]

I was freaked out by my EP thre weeks ago..quoted 1 in 500 risk in first few days...I switched off the n but hubby was with me and asked.how many strokes have you seen? Answer..in10 years....1.

[jedimasterlincoln in reply to wilsond]

Yeah most of my risks I got quoted yesterday were 1% or less

[Mike11]

My EP said in the over 1000 ablations he's performed, two strokes were triggered but one of those was ended before any damage was done.

[Hidden]

I hadn't realised there was an increased risk immediately post ablation.....oh dear , more worry.

[jedimasterlincoln in reply to Hidden]

oops.

[Hidden in reply to Hidden]

As I'm 2 weeks away from my ablation, I'm finding posts like this a bit disturbing so might have a break for a while as I'm prone to anxieties.

[Hidden in reply to Hidden]

I do understand how you are feeling Scoobizu. I have had 3 ablations, the first in 2009, then 2011 and 2013. Before my first there was very little information about so anything I learnt was from medical books in the library and an internet site in the USA. Even so I was very reluctant right up until I stepped into the Cath lab . I came out of these unscathed. However I'm on the list for a 4th ablation but will hold back if I feel it's not necessary.

Do remember that there are so many ablations being performed these days and subsequently operators more experienced and skilled. You will find that you will be very well looked after during the procedure with all the attention on your safety.

Best wishes

Sandra

[seasider18 in reply to Hidden]

At the assessment prior to my pacemaker being fitted I was told that the cath lab is the safest place in the world. Even then I ended up with a pneumothorax. It and the draining of my lung was the most painful experience I have ever had and I have been through a lot in my time.

[MarkS]

The risk of stroke during/after an ablation is quite high. That's why it's essential to continue with your normal anticoagulant throughout the ablation. See "Periprocedural Stroke and Bleeding Complications in Patients Undergoing Catheter Ablation of Atrial Fibrillation With Different Anticoagulation Management":

ahajournals.org/doi/full/10...

This found a rate of 3.7% for strokes and 1.3% for TIAs in a group that stopped using warfarin and bridged with heparin whereas the rate was only 0.25% in those with continuous warfarin.

This study used warfarin but there are similar results with NOACs provided they are used continuously and not stopped at all.

[jedimasterlincoln in reply to MarkS]

Thanks mark! That's what I couldn't find!

[Hidden in reply to MarkS]

Excellent and very reassuring. Thank you.

[Hidden in reply to MarkS]

Good to know! Must make sure my warfarin is not stopped when the time comes.

[DerekMcAvoy]

1/100 according to the literature I’ve just been given by the hospital

[Hidden]

That's hard to believe unless the ablation is done without following pre and periprocedural anticoagulation guidelines and/or TOE.

I could not find that stat in the download, did not seem to be in 6.1. Can you pinpoint it? Thanks.

[Aus19]

This is a very important question for some AF patients - especially me. I asked my EP this very question last month. I’m 51, paroxysmal AF, no hypertension or co-morbidities, very lean, non-smoker. But my AF was diagnosed after I had a (mild) stroke last October. So I have a CHADS2 score of 2. Anyway, my EP estimated my stroke risk at 5 per cent. He made it clear that this was an approximation. He pointed out that the risk could be considered binary if individuated - either I would have a stroke or I wouldn’t. But, in a broader sense for a stratified population of ablation patients with my health profile, his estimate was 5 per cent. This was very sobering. My risk is higher because - obviously - I have already had one stroke. So, for me, I will be exhausting all pharmacological options before having an ablation. For me, the risk outweighs the benefits at this stage. As my AF progresses, I expect that I will revise this decision. But at the moment my AF is tolerable. Having a stroke is frightening - I know from experience.

[Hidden in reply to Aus19]

I understand and can appreciate your decision Aus19. Stroke is a big fear. We are told that an ablation is rarely a cure but an attempt to improve Quality of Life.

TOE s are normally performed prior to ablation here in UK.At least they were for all 3 of mine in London and Brighton.

[Aus19]

I wanted to add that, at least here in Australia, it is standard practice for the EP to perform a trans-oesphogeal echocardiogram immediately prior to the ablation. This can find any clots in the atria and thus “intercept” any stroke. I understand that this may not be the standard procedure in every country.

[Hidden]

I understand the old adage that knowledge is power and respect everyone’s right to ask anything they wish but this question has clearly frightened some people who are about to have or are considering to have an ablation. Just a thought!

[Hidden in reply to Hidden]

You are right Flapjack. Anyone harbouring thoughts of uncertainty could be swayed against. On the other hand we have a right to have all these figures presented to us.

[jedimasterlincoln in reply to Hidden]

I'm aware there are many people here at many stages of their AF journey and with varying levels of knowledge and understanding but I couldnt let this be a barrier to my wanting to know something others may not. I think its more than reasonable to expect a broad range of information in groups such as this.

[Hidden in reply to jedimasterlincoln]

I’m really pleased for you that you got the answer you was seeking to your question and hope that you find it useful........

[Hidden in reply to jedimasterlincoln]

AF ablation is a procedure that carries a number of measurable small and very small risks, The title of the thread is clear, there is no compulsion to read it. I found the information given by ectopic1 and MarkS very helpful. The figures suggest the risk of a TIA or small stroke are 1 in 400 at worst.

Thank you for your post jedimasterlincoln. We are none of us children.

[Hidden]

Thank you. The references cite papers between 9 and 16 years old, but give no links. So not able to tease out the detail. Perhaps the figure of 7% relates to high risk patients; and again, where AC protocols have not been strictly followed.

[Hidden]

Thank you. It must have taken considerable time to put this together. There is a lot of interesting information here, not just around morbidity. My impression is that there is in the right hands, a very low risk of very serious complications. The high figures for clinically silent micro-emboli identified by diffusion weighted MRI is a concern, though most resolve fairly quickly. The long term impact on cognitive function, though presumably unmeasured, remains a concern.

Your final link unlocks many papers unavailable free to most of us, and for that too thank you.