Ablation of atrial fibrillation under therapeutic warfarin reduces periprocedural complications evidence from a meta-analysis

Pasquale Santangeli, Luigi Di Biase, Rodney Horton, J. David Burkhardt, Javier Sanchez, Amin Al-Ahmad, Richard Hongo, Salwa Beheiry, Rong Bai, Prasant Mohanty, William R. Lewis, Andrea Natale

Research output: Contribution to journalArticle

126 Citations (Scopus)

Abstract

Background-Observational data suggest that performing radiofrequency catheter ablation of atrial fibrillation (AF) under therapeutic warfarin (continuous warfarin [CW]) may reduce the periprocedural risk of complications, such as thromboembolic events, compared to warfarin discontinuation (DW) with periprocedural bridging with heparin. We systematically reviewed the available evidence on the impact of CW compared with DW on periprocedural complications of AF catheter ablation. Methods and Results-We searched major Web databases for studies on radiofrequency catheter ablation of AF under CW versus DW with periprocedural bridging with heparin. Data on periprocedural complications were extracted. We identified 9 studies (1 large case series indirectly compared with the latest Worldwide Survey). A total of 27 402 patients were included in the analysis (6400 undergoing ablation with CW). CW was associated with a striking decrease of thromboembolic complications (OR, 0.10; 95% CI, 0.05- 0.23; P<0.001) and minor bleeding complications (OR, 0.38; 95% CI, 0.21- 0.71; P=0.002) compared with DW. CW also did not increase the risk of major bleeding (OR, 0.67; 95% CI, 0.31-1.43; P=0.30), including cardiac tamponade (OR, 0.69; 95% CI, 0.19 -2.47; P=0.57). Conclusions-There is highly consistent evidence from observational studies that a CW strategy during radiofrequency catheter ablation of AF reduces the risk of thromboembolic complications without increasing the risk of bleeding.

Original languageEnglish (US)
Pages (from-to)302-311
Number of pages10
JournalCirculation: Arrhythmia and Electrophysiology
Volume5
Issue number2
DOIs
StatePublished - Apr 2012
Externally publishedYes

Fingerprint

Warfarin
Atrial Fibrillation
Meta-Analysis
Catheter Ablation
Therapeutics
Hemorrhage
Heparin
Cardiac Tamponade
Observational Studies
Databases

Keywords

  • Anticoagulants
  • Atrial fibrillation
  • Catheter ablation
  • Complications

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

Cite this

Ablation of atrial fibrillation under therapeutic warfarin reduces periprocedural complications evidence from a meta-analysis. / Santangeli, Pasquale; Di Biase, Luigi; Horton, Rodney; Burkhardt, J. David; Sanchez, Javier; Al-Ahmad, Amin; Hongo, Richard; Beheiry, Salwa; Bai, Rong; Mohanty, Prasant; Lewis, William R.; Natale, Andrea.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 5, No. 2, 04.2012, p. 302-311.

Research output: Contribution to journalArticle

Santangeli, P, Di Biase, L, Horton, R, Burkhardt, JD, Sanchez, J, Al-Ahmad, A, Hongo, R, Beheiry, S, Bai, R, Mohanty, P, Lewis, WR & Natale, A 2012, 'Ablation of atrial fibrillation under therapeutic warfarin reduces periprocedural complications evidence from a meta-analysis', Circulation: Arrhythmia and Electrophysiology, vol. 5, no. 2, pp. 302-311. https://doi.org/10.1161/CIRCEP.111.964916
Santangeli, Pasquale ; Di Biase, Luigi ; Horton, Rodney ; Burkhardt, J. David ; Sanchez, Javier ; Al-Ahmad, Amin ; Hongo, Richard ; Beheiry, Salwa ; Bai, Rong ; Mohanty, Prasant ; Lewis, William R. ; Natale, Andrea. / Ablation of atrial fibrillation under therapeutic warfarin reduces periprocedural complications evidence from a meta-analysis. In: Circulation: Arrhythmia and Electrophysiology. 2012 ; Vol. 5, No. 2. pp. 302-311.
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abstract = "Background-Observational data suggest that performing radiofrequency catheter ablation of atrial fibrillation (AF) under therapeutic warfarin (continuous warfarin [CW]) may reduce the periprocedural risk of complications, such as thromboembolic events, compared to warfarin discontinuation (DW) with periprocedural bridging with heparin. We systematically reviewed the available evidence on the impact of CW compared with DW on periprocedural complications of AF catheter ablation. Methods and Results-We searched major Web databases for studies on radiofrequency catheter ablation of AF under CW versus DW with periprocedural bridging with heparin. Data on periprocedural complications were extracted. We identified 9 studies (1 large case series indirectly compared with the latest Worldwide Survey). A total of 27 402 patients were included in the analysis (6400 undergoing ablation with CW). CW was associated with a striking decrease of thromboembolic complications (OR, 0.10; 95{\%} CI, 0.05- 0.23; P<0.001) and minor bleeding complications (OR, 0.38; 95{\%} CI, 0.21- 0.71; P=0.002) compared with DW. CW also did not increase the risk of major bleeding (OR, 0.67; 95{\%} CI, 0.31-1.43; P=0.30), including cardiac tamponade (OR, 0.69; 95{\%} CI, 0.19 -2.47; P=0.57). Conclusions-There is highly consistent evidence from observational studies that a CW strategy during radiofrequency catheter ablation of AF reduces the risk of thromboembolic complications without increasing the risk of bleeding.",
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AU - Burkhardt, J. David

AU - Sanchez, Javier

AU - Al-Ahmad, Amin

AU - Hongo, Richard

AU - Beheiry, Salwa

AU - Bai, Rong

AU - Mohanty, Prasant

AU - Lewis, William R.

AU - Natale, Andrea

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