BACKGROUND: The new oral anticoagulants (NOAC), dabigatran and rivaroxaban, have been demonstrated to be at least equivalent to warfarin for preventing cardiac thromboembolism (TE) in patients with atrial fibrillation (AF). However, there is limited data regarding use around catheter ablation (CA) procedures. OBJECTIVE: We evaluated the risk of bleeding and TE complications associated with NOAC use during AF ablation. METHODS: Consecutive patients undergoing AF ablation between January 2011 and 6 September 2013 were grouped based on peri-procedural anticoagulation regimen: (1) uninterrupted warfarin with therapeutic INR (WARF), n = 114, (2) dabigatran, n = 89, or (3) rivaroxaban, n = 98. NOACs were held for 24 h (dabigatran) or 36 h (rivaroxaban) prior to the procedure. Heparin infusion was initiated 6 h post-procedure for the NOAC groups; NOACs were resumed the morning after the procedure. Antral PVI was performed with activated clotting time (ACT) maintained >300 s. TE or bleeding complications during ablation and through 30 days were compared. RESULTS: Three hundred and one patients underwent ablation for paroxysmal (71%) or persistent (29%) AF. International Normalization Ratio (INR) for the WARF group was 2.0 ± 0.5. Baseline characteristics were similar among the groups. There were two TE events (asymptomatic cerebral emboli and TIA), and there were 17 bleeding events (large hematoma n = 4; pericardial effusion n = 6; persistent hematuria n = 1; pseudoaneurism/AV fistula n = 6). Of the six pericardial effusions, three required drainage. There was no significant difference in combined TE/bleeding risk among the groups (WARF vs. dabigatran vs. rivaroxaban; 6.2% vs. 6.7% vs. 6.0%; p = 0.82) CONCLUSIONS: In this group of AF patients undergoing CA, use of peri-procedure dabigatran or rivaroxaban compared to uninterrupted warfarin did not lead to an increase in bleeding or TE complications.
BACKGROUND: The new oral anticoagulants (NOAC), dabigatran and rivaroxaban, have been demonstrated to be at least equivalent to warfarin for preventing cardiac thromboembolism (TE) in patients with atrial fibrillation (AF). However, there is limited data regarding use around catheter ablation (CA) procedures. OBJECTIVE: We evaluated the risk of bleeding and TE complications associated with NOAC use during AF ablation. METHODS: Consecutive patients undergoing AF ablation between January 2011 and 6 September 2013 were grouped based on peri-procedural anticoagulation regimen: (1) uninterrupted warfarin with therapeutic INR (WARF), n = 114, (2) dabigatran, n = 89, or (3) rivaroxaban, n = 98. NOACs were held for 24 h (dabigatran) or 36 h (rivaroxaban) prior to the procedure. Heparin infusion was initiated 6 h post-procedure for the NOAC groups; NOACs were resumed the morning after the procedure. Antral PVI was performed with activated clotting time (ACT) maintained >300 s. TE or bleeding complications during ablation and through 30 days were compared. RESULTS: Three hundred and one patients underwent ablation for paroxysmal (71%) or persistent (29%) AF. International Normalization Ratio (INR) for the WARF group was 2.0 ± 0.5. Baseline characteristics were similar among the groups. There were two TE events (asymptomatic cerebral emboli and TIA), and there were 17 bleeding events (large hematoma n = 4; pericardial effusion n = 6; persistent hematuria n = 1; pseudoaneurism/AV fistula n = 6). Of the six pericardial effusions, three required drainage. There was no significant difference in combined TE/bleeding risk among the groups (WARF vs. dabigatran vs. rivaroxaban; 6.2% vs. 6.7% vs. 6.0%; p = 0.82) CONCLUSIONS: In this group of AFpatients undergoing CA, use of peri-procedure dabigatran or rivaroxaban compared to uninterrupted warfarin did not lead to an increase in bleeding or TE complications.
Authors: L Samuel Wann; Anne B Curtis; Craig T January; Kenneth A Ellenbogen; James E Lowe; N A Mark Estes; Richard L Page; Michael D Ezekowitz; David J Slotwiner; Warren M Jackman; William G Stevenson; Cynthia M Tracy; Valentin Fuster; Lars E Rydén; David S Cannom; Jean-Yves Le Heuzey; Harry J Crijns; James E Lowe; Anne B Curtis; S Bertil Olsson; Kenneth A Ellenbogen; Eric N Prystowsky; Jonathan L Halperin; Juan Luis Tamargo; G Neal Kay; L Samuel Wann; Alice K Jacobs; Jeffrey L Anderson; Nancy Albert; Judith S Hochman; Christopher E Buller; Frederick G Kushner; Mark A Creager; Erik Magnus Ohman; Steven M Ettinger; William G Stevenson; Robert A Guyton; Lynn G Tarkington; Jonathan L Halperin; Clyde W Yancy Journal: J Am Coll Cardiol Date: 2010-12-21 Impact factor: 24.094
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; Jose 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: J Interv Card Electrophysiol Date: 2012-03 Impact factor: 1.900
Authors: Daniel W Kaiser; Megan M Streur; Rangadham Nagarakanti; S Patrick Whalen; Christopher R Ellis Journal: J Interv Card Electrophysiol Date: 2013-04-28 Impact factor: 1.900
Authors: Ayman A Hussein; David O Martin; Walid Saliba; Deven Patel; Saima Karim; Omar Batal; Mustafa Banna; Michelle Williams-Andrews; Minerva Sherman; Mohamed Kanj; Mandeep Bhargava; Thomas Dresing; Thomas Callahan; Patrick Tchou; Luigi Di Biase; Salwa Beheiry; Bruce Lindsay; Andrea Natale; Oussama Wazni Journal: Heart Rhythm Date: 2009-07-10 Impact factor: 6.343
Authors: Stuart J Connolly; Michael D Ezekowitz; Salim Yusuf; John Eikelboom; Jonas Oldgren; Amit Parekh; Janice Pogue; Paul A Reilly; Ellison Themeles; Jeanne Varrone; Susan Wang; Marco Alings; Denis Xavier; Jun Zhu; Rafael Diaz; Basil S Lewis; Harald Darius; Hans-Christoph Diener; Campbell D Joyner; Lars Wallentin Journal: N Engl J Med Date: 2009-08-30 Impact factor: 91.245
Authors: Charlotte Eitel; Julia Koch; Philipp Sommer; Silke John; Simon Kircher; Andreas Bollmann; Arash Arya; Christopher Piorkowski; Gerhard Hindricks Journal: Europace Date: 2013-05-22 Impact factor: 5.214
Authors: Mohamed Bassiouny; Walid Saliba; John Rickard; Mingyuan Shao; Albert Sey; Mariam Diab; David O Martin; Ayman Hussein; Maurice Khoury; Bernard Abi-Saleh; Samir Alam; Jay Sengupta; P Peter Borek; Bryan Baranowski; Mark Niebauer; Thomas Callahan; Niraj Varma; Mina Chung; Patrick J Tchou; Mohamed Kanj; Thomas Dresing; Bruce D Lindsay; Oussama Wazni Journal: Circ Arrhythm Electrophysiol Date: 2013-04-03
Authors: Martin Martinek; Marianne Gwechenberger; Daniel Scherr; Clemens Steinwender; Markus Stühlinger; Helmut Pürerfellner; Franz Xaver Roithinger; Lukas Fiedler Journal: Wien Klin Wochenschr Date: 2018-01-25 Impact factor: 1.704