Document Detail

Pulmonary vein antrum isolation for atrial fibrillation on therapeutic coumadin: special considerations.
MedLine Citation:
PMID:  21044211     Owner:  NLM     Status:  MEDLINE    
Pulmonary vein antrum isolation (PVAI) has emerged as an effective treatment for drug-refractory atrial fibrillation (AF). However, thromboembolic events are important complications of this approach. Management of anticoagulation is essential to prevent thromboembolic complications and avoid bleeding complications. The purpose of this review is to outline the general principles followed at our AF centers to address the important issue of pre-, peri-, and postprocedural anticoagulation strategies during PVAI of AF. We initiate warfarin therapy prior to the ablation procedure and continue it through the procedure. Prior work has demonstrated that continuation of therapeutic warfarin during the radiofrequency catheter ablation reduces the risk of periprocedural stroke/transient ischemic attack without increasing the risk of hemorrhagic events. In fact, a strategy that interrupts warfarin anticoagulation may increase the risk of stroke, even with bridging with enoxaparin. Data from our work have shown that minor bleeding was more frequent in the patients bridged with heparin or enoxaparin. There was no significant difference in incidence of major bleeding complications among the patients with a therapeutic level of international normalized ratio (INR) compared with patients for whom bridging therapy was used. Furthermore, the strategy of ablation during a therapeutic INR could be more economical compared with bridging therapy with enoxaparin. Continuation of therapeutic warfarin during ablation of AF may be the best strategy, especially in patients with nonparoxysmal AF, patients with higher thromboembolic risk scores, and patients who require extensive ablation during PVAI of AF.
Devi Gopinath; William R Lewis; Luigi Di Biase; Andrea Natale
Publication Detail:
Type:  Journal Article     Date:  2010-11-02
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  22     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-02-14     Completed Date:  2011-06-17     Revised Date:  2012-01-04    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  236-9     Citation Subset:  IM    
Copyright Information:
© 2010 Wiley Periodicals, Inc.
MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA.
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MeSH Terms
Anticoagulants / therapeutic use
Atrial Fibrillation / mortality*,  surgery*
Catheter Ablation / mortality*
Postoperative Complications / mortality,  prevention & control
Pulmonary Veins / surgery*
Risk Assessment
Risk Factors
Survival Analysis
Survival Rate
Thromboembolism / mortality*,  prevention & control*
Warfarin / therapeutic use*
Reg. No./Substance:
0/Anticoagulants; 81-81-2/Warfarin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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