BACKGROUND: Observational data suggest that performing radiofrequency catheter ablation of atrial fibrillation (AF) under therapeutic warfarin (continuous warfarin [CW]) may reduce the periprocedural risk of complications, such as thromboembolic events, compared to warfarin discontinuation (DW) with periprocedural bridging with heparin. We systematically reviewed the available evidence on the impact of CW compared with DW on periprocedural complications of AF catheter ablation. METHODS AND RESULTS: We searched major Web databases for studies on radiofrequency catheter ablation of AF under CW versus DW with periprocedural bridging with heparin. Data on periprocedural complications were extracted. We identified 9 studies (1 large case series indirectly compared with the latest Worldwide Survey). A total of 27,402 patients were included in the analysis (6400 undergoing ablation with CW). CW was associated with a striking decrease of thromboembolic complications (OR, 0.10; 95% CI, 0.05-0.23; P<0.001) and minor bleeding complications (OR, 0.38; 95% CI, 0.21-0.71; P=0.002) compared with DW. CW also did not increase the risk of major bleeding (OR, 0.67; 95% CI, 0.31-1.43; P=0.30), including cardiac tamponade (OR, 0.69; 95% CI, 0.19-2.47; P=0.57). CONCLUSIONS: There is highly consistent evidence from observational studies that a CW strategy during radiofrequency catheter ablation of AF reduces the risk of thromboembolic complications without increasing the risk of bleeding.
BACKGROUND: Observational data suggest that performing radiofrequency catheter ablation of atrial fibrillation (AF) under therapeutic warfarin (continuous warfarin [CW]) may reduce the periprocedural risk of complications, such as thromboembolic events, compared to warfarin discontinuation (DW) with periprocedural bridging with heparin. We systematically reviewed the available evidence on the impact of CW compared with DW on periprocedural complications of AF catheter ablation. METHODS AND RESULTS: We searched major Web databases for studies on radiofrequency catheter ablation of AF under CW versus DW with periprocedural bridging with heparin. Data on periprocedural complications were extracted. We identified 9 studies (1 large case series indirectly compared with the latest Worldwide Survey). A total of 27,402 patients were included in the analysis (6400 undergoing ablation with CW). CW was associated with a striking decrease of thromboembolic complications (OR, 0.10; 95% CI, 0.05-0.23; P<0.001) and minor bleeding complications (OR, 0.38; 95% CI, 0.21-0.71; P=0.002) compared with DW. CW also did not increase the risk of major bleeding (OR, 0.67; 95% CI, 0.31-1.43; P=0.30), including cardiac tamponade (OR, 0.69; 95% CI, 0.19-2.47; P=0.57). CONCLUSIONS: There is highly consistent evidence from observational studies that a CW strategy during radiofrequency catheter ablation of AF reduces the risk of thromboembolic complications without increasing the risk of bleeding.
Authors: Melanie Gunawardene; S Willems; B Schäffer; J Moser; R Ö Akbulak; M Jularic; C Eickholt; J Nührich; C Meyer; P Kuklik; S Sehner; V Czerner; B A Hoffmann Journal: Clin Res Cardiol Date: 2016-07-19 Impact factor: 5.460
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: Heart Rhythm Date: 2017-05-12 Impact factor: 6.343
Authors: Hugh Calkins; Karl Heinz Kuck; Riccardo Cappato; Josep Brugada; A John Camm; Shih-Ann Chen; Harry J G Crijns; Ralph J Damiano; D Wyn Davies; John DiMarco; James Edgerton; Kenneth Ellenbogen; Michael D Ezekowitz; David E Haines; Michel Haissaguerre; Gerhard Hindricks; Yoshito Iesaka; Warren Jackman; José Jalife; Pierre Jais; Jonathan Kalman; David Keane; Young-Hoon Kim; Paulus Kirchhof; George Klein; Hans Kottkamp; Koichiro Kumagai; Bruce D Lindsay; Moussa Mansour; Francis E Marchlinski; Patrick M McCarthy; J Lluis Mont; Fred Morady; Koonlawee Nademanee; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Douglas L Packer; Carlo Pappone; Eric Prystowsky; Antonio Raviele; Vivek Reddy; Jeremy N Ruskin; Richard J Shemin; Hsuan-Ming Tsao; David Wilber Journal: Heart Rhythm Date: 2012-03-01 Impact factor: 6.343