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Left atrial catheter ablation and ischemic stroke.

Authors
  • Haeusler, Karl Georg
  • Kirchhof, Paulus
  • Endres, Matthias
Type
Published Article
Journal
Stroke
Publisher
Ovid Technologies Wolters Kluwer -American Heart Association
Publication Date
Jan 01, 2012
Volume
43
Issue
1
Pages
265–270
Identifiers
DOI: 10.1161/STROKEAHA.111.627067
PMID: 22156699
Source
Medline
License
Unknown

Abstract

Left atrial catheter ablation (LACA) has become an established therapy to abolish drug-refractory symptomatic paroxysmal and persistent atrial fibrillation. Restoring sinus rhythm by LACA may help to prevent atrial fibrillation-related strokes, but presently there is no evidence from randomized clinical trials to support this notion. This review summarizes the current knowledge and uncertainties regarding LACA and procedure-related ischemic stroke. In fact, most patients who undergo LACA have a rather low annual stroke risk even when left untreated, whereas LACA imposes a risk of procedure-related stroke of ≈0.5% to 1%. In addition, LACA may cause cerebral microemboli, resulting in ischemic lesions. These cerebral lesions, detectable by high-resolution MRI, could contribute to neuropsychological deficits and cognitive dysfunction. Furthermore, recurrent atrial fibrillaton episodes can be detected up to years after LACA and might cause ischemic strokes, especially in those patients in whom therapeutic anticoagulation was discontinued. Further prospective multicenter trials are needed to identify procedure-dependent risk factors for stroke and to optimize postprocedural anticoagulation management.

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