BACKGROUND: Periprocedural anticoagulation using uninterrupted warfarin could reduce the risk of thromboembolic complications of atrial fibrillation (AF) ablation. Few studies, however, have evaluated the efficacy and safety of periprocedural dabigatran in AF ablation. METHODS AND RESULTS: A total of 211 consecutive patients who underwent AF ablation, including 110 patients who received 110mg dabigatran twice daily (group D) and 101 patients who received dose-adjusted warfarin (international normalized ratio, 2.0-3.0; group W), were evaluated. Dabigatran was discontinued on the morning of the procedure, and resumed on the next morning. Warfarin was continued throughout the procedure. During the procedure, heparin infusion was maintained to achieve an activated clotting time of >300s. Postprocedural cerebral magnetic resonance imaging (MRI) was performed in 60 patients (group D, n=31; group W, n=29). No periprocedural deaths or symptomatic thromboembolic complications were observed in either group. MRI indicated a silent cerebral infarction in 1 patient in each group. Five patients in group D and 11 in group W had minor bleeding (P=0.12). Cardiac tamponade occurred in 2 patients in group W, but in none in group D. Total bleeding complications occurred less frequently in group D (4.5%) than in group W (12.9%; P<0.05). CONCLUSIONS: Dabigatran at a dose of 110mg twice daily was safe for AF ablation in patients with a relatively low risk of thromboemboli, suggesting that it may become an alternative to warfarin in those patients.
BACKGROUND: Periprocedural anticoagulation using uninterrupted warfarin could reduce the risk of thromboembolic complications of atrial fibrillation (AF) ablation. Few studies, however, have evaluated the efficacy and safety of periprocedural dabigatran in AF ablation. METHODS AND RESULTS: A total of 211 consecutive patients who underwent AF ablation, including 110 patients who received 110mg dabigatran twice daily (group D) and 101 patients who received dose-adjusted warfarin (international normalized ratio, 2.0-3.0; group W), were evaluated. Dabigatran was discontinued on the morning of the procedure, and resumed on the next morning. Warfarin was continued throughout the procedure. During the procedure, heparin infusion was maintained to achieve an activated clotting time of >300s. Postprocedural cerebral magnetic resonance imaging (MRI) was performed in 60 patients (group D, n=31; group W, n=29). No periprocedural deaths or symptomatic thromboembolic complications were observed in either group. MRI indicated a silent cerebral infarction in 1 patient in each group. Five patients in group D and 11 in group W had minor bleeding (P=0.12). Cardiac tamponade occurred in 2 patients in group W, but in none in group D. Total bleeding complications occurred less frequently in group D (4.5%) than in group W (12.9%; P<0.05). CONCLUSIONS:Dabigatran at a dose of 110mg twice daily was safe for AF ablation in patients with a relatively low risk of thromboemboli, suggesting that it may become an alternative to warfarin in those patients.
Authors: Benjamin A Steinberg; Vic Hasselblad; Brett D Atwater; Tristram D Bahnson; Jeffrey B Washam; John H Alexander; James P Daubert; Jonathan P Piccini Journal: J Interv Card Electrophysiol Date: 2013-07-24 Impact factor: 1.900
Authors: Ingrid Pabinger; Wilfried Lang; Franz Xaver Roithinger; Franz Weidinger; Sabine Eichinger-Hasenauer; Reinhold Glehr; Walter-Michael Halbmayer; Hans-Peter Haring; Bernd Jilma; Hans Christian Korninger; Sibylle Kozek-Langenecker; Paul Kyrle; Herbert Watzke; Ansgar Weltermann; Johann Willeit; Kurt Huber Journal: Wien Klin Wochenschr Date: 2014-10-03 Impact factor: 1.704
Authors: Aysha Arshad; Christopher K Johnson; Suneet Mittal; Eric Buch; Ismail Hamam; Thanh Tran; Richard E Shaw; Dan Musat; Mark Preminger; Tina Sichrovsky; Bengt Herweg; Kalyanam Shivkumar; John Hummel; Jonathan S Steinberg Journal: Pacing Clin Electrophysiol Date: 2014-05-04 Impact factor: 1.976