The Lead Episode 49: Stroke and Bleeding Risks of Endocardial Ablation for Ventricular Arrhythmias-JACC Electrophysiology (visual aid)

JACC Electrophysiology (visual aid)

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A new study evaluated the risks of stroke and bleeding complications in patients undergoing endocardial catheter ablation for ventricular arrhythmias. The study included 663 procedures in 616 patients, with a median age of 64 years. The researchers found that the incidence of stroke was low, occurring in only 0.3% of procedures. The most common serious complication was pericardial effusion, which occurred in 1.7% of procedures. Vascular access complications, such as bleeding, occurred in 4.2% of procedures. <br /><br />The study also examined the use of antithrombotic medications before and after the procedure. Prior to the procedure, 70% of patients were taking antithrombotic agents, including aspirin, warfarin, or direct acting oral anticoagulants (DOACs). After the procedure, the most common regimen was aspirin 325 mg/day, which was used in 49.8% of patients. DOACs or warfarin were used in 30.3% of patients. New DOAC or warfarin administration was initiated in only 6.6% of patients. <br /><br />The study found that preprocedure non-ASA antiplatelet use and DOAC use were associated with an increased risk of bleeding complications. However, the incidence of embolic events was very low, suggesting that the current antithrombotic regimens are generally effective in preventing stroke. The study concluded that a tailored approach to antithrombotic therapy with aspirin 325 mg/day as a minimal postprocedure regimen is reasonable for most patients, with more potent regimens reserved for selected patients.

Keywords

stroke

bleeding complications

endocardial catheter ablation

ventricular arrhythmias

pericardial effusion

vascular access complications

antithrombotic medications

aspirin

warfarin

DOACs