Late-Phase Thromboembolism After Catheter Ablation for Paroxysmal Atrial Fibrillation

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Background:The aim of this study was to investigate the incidence and predictors (which have not previously been fully elucidated) of late-phase thromboembolism (TE) after catheter ablation (CA) for paroxysmal atrial fibrillation (AF).Methods and Results:We studied 1,156 consecutive patients (61±10 years; 891 men; CHADS₂score, 0.8±1.0) after CA for symptomatic paroxysmal AF and examined the details of late-phase TE. During a follow-up of 49.5±21.9 months (median, 47 months; range, 6–113 months) after CA, 9 patients (0.78%) developed late-phase TE, all of which were ischemic stroke. Of these, 5 patients with AF recurrence experienced cardioembolism; the AF was asymptomatic at recurrence. The remaining 4 without AF recurrence experienced cardioembolism (n=1), small-vessel occlusion (n=1), large-artery atherosclerosis (n=1), and stroke of other determined etiology (n=1). On Kaplan-Meier analysis patients with structural heart disease (P=0.003), AF recurrence after the final CA (P=0.01), prior stroke (P=0.002), CHADS₂score ≥2 (P=0.0002), left ventricular ejection fraction <50% (P<0.0001), and spontaneous echo contrast on transesophageal echocardiogram (P=0.0004) had a significantly higher risk of late-phase TE. Multivariate analysis indicated that CHADS₂score ≥2 (HR, 4.49; 95% CI: 1.08–22.56; P=0.04) independently predicted late-phase TE.Conclusions:The incidence of TE was low after CA for paroxysmal AF, but CHADS₂score ≥2 independently increased the risk of late-phase TE. (Circ J 2014; 78: 2394–2401)