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Catheter ablation for atrial fibrillation on uninterrupted warfarin: can it be done without echo guidance?
MedLine Citation:
PMID:  21040095     Owner:  NLM     Status:  In-Data-Review    
AF Ablation on Uninterrupted Warfarin. Introduction: Catheter ablation for atrial fibrillation is an effective treatment for symptomatic patients who have failed drug therapy. Recent studies using intracardiac echocardiography have demonstrated that ablation can be performed safely on uninterrupted warfarin and may be superior to bridging low molecular weight heparin (LMWH). We sought to assess the safety of an uninterrupted warfarin protocol using a simplified ablation protocol in a prospective controlled study. Methods: Two anticoagulation regimes for patients undergoing catheter ablation for atrial fibrillation were evaluated-a bridging LMWH group and an uninterrupted warfarin group. Bleeding complications were compared between the 2 groups. Results: In total 198 patients were evaluated (109 bridging LMWH, 89 uninterrupted warfarin). The preprocedure INR in the LMWH group (mean age 60.6 years, 72% male) was 1.2 ± 0.3 compared to 2.3 ± 0.5 in the uninterrupted warfarin group (mean age 60.9 years, 69% male). The primary outcome (a composite of major and minor bleeding complications) was observed in 78% in the LMWH group compared to 56% in the warfarin group (P = 0.001), mainly due to increased pain at the venous access site (41% vs 16%, P = 0.001). Two patients undergoing ablation on warfarin required pericardiocentesis for cardiac tamponade. Drug costs were lower in the warfarin group ($64.77 ± 31.86 vs $20.76 ± 15.60, P = 0.005), but the overall cost of treatment per patient (including bed occupancy costs) was similar in the LMWH group compared to the warfarin group ($883.96 ± 278.78 vs $816.59 ± 182.72, P = 0.06). Conclusion: Catheter ablation for atrial fibrillation can be performed safely on uninterrupted warfarin without intracardiac echocardiography, with a reduced risk of bleeding complications. (J Cardiovasc Electrophysiol, Vol. 22, pp. 265-270, March 2011).
Stephen P Page; M Shoaib Siddiqui; Malcolm Finlay; Ross J Hunter; Dominic J Abrams; Mehul Dhinoja; Mark J Earley; Simon C Sporton; Richard J Schilling
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Publication Detail:
Type:  Journal Article     Date:  2010-10-06
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  22     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-03-09     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  265-70     Citation Subset:  IM    
Copyright Information:
© 2010 Wiley Periodicals, Inc.
Department of Electrophysiology, St. Bartholomew's Hospital, London, UK.
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