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Radiofrequency ablation of atrial fibrillation under therapeutic international normalized ratio: a safe and efficacious periprocedural anticoagulation strategy.

Abstract：

BACKGROUND:The best periprocedural anticoagulation strategy at the time of pulmonary vein isolation (PVI) is not known. Most centers stop administering warfarin (Coumadin) and use bridging with heparin or enoxaparin. OBJECTIVE:The purpose of this study was to evaluate the efficacy and safety of PVI under therapeutic international normalized ratio (INR). METHODS:Between January 2005 and December 2008, PVI was performed in 3,052 patients with therapeutic INR (> or =1.8) at the time of ablation. All patients were evaluated for ischemic strokes and bleeding complications. RESULTS:Mean INR was 2.53 +/- 0.62. Only 3 (0.098%) patients had ischemic strokes. One patient had a hemorrhagic stroke on the third day postablation but recovered completely by 1-week follow-up. Bleeding complications occurred in 34 (1.11%) patients; most were minor (0.79%). Major hemorrhagic complications occurred in 10 (0.33%) patients (tamponade in 5, hematomas requiring intervention in 2, transfusion necessary in 3). CONCLUSION:In a large patient population, continuation of Coumadin at a therapeutic INR at the time of PVI without use of heparin or enoxaparin for bridging is a safe and efficacious periprocedural anticoagulation strategy. It is an acceptable and potentially better alternative to strategies that use bridging with heparin or enoxaparin.

journal_name

Heart Rhythm

journal_title

Heart rhythm

authors

Hussein AA,Martin DO,Saliba W,Patel D,Karim S,Batal O,Banna M,Williams-Andrews M,Sherman M,Kanj M,Bhargava M,Dresing T,Callahan T,Tchou P,Di Biase L,Beheiry S,Lindsay B,Natale A,Wazni O

doi

10.1016/j.hrthm.2009.07.007

subject

Has Abstract

pub_date

2009-10-01 00:00:00

pages

1425-9

issue

10

eissn

1547-5271

issn

1556-3871

pii

S1547-5271(09)00746-2

journal_volume

6

pub_type

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