Atrial fibrillation ablation in patients with therapeutic international normalized ratio

Comparison of strategies of anticoagulation management in the periprocedural period

Oussama M. Wazni, Salwa Beheiry, Tamer Fahmy, Conor Barrett, Steven Hao, Dimpi Patel, Luigi Di Biase, David O. Martin, Mohamed Kanj, Mauricio Arruda, Jennifer Cummings, Robert Schweikert, Walid Saliba, Andrea Natale

Research output: Contribution to journalArticle

215 Citations (Scopus)

Abstract

BACKGROUND - The best approach to management of anticoagulation before and after atrial fibrillation ablation is not known. METHODS AND RESULTS - We compared outcomes in consecutive patients undergoing pulmonary vein antrum isolation for persistent atrial fibrillation. Early in our practice, warfarin was stopped 3 days before ablation, and a transesophageal echocardiogram was performed to rule out clot. Enoxaparin, initially 1 mg/kg twice daily (group 1) and then 0.5 mg/kg twice daily (group 2), was used to "bridge" patients after ablation. Subsequently, warfarin was continued to maintain the international normalized ratio between 2 and 3.5 (group 3). Minor bleeding was defined as hematoma that did not require intervention. Major bleeding was defined as either cardiac tamponade, hematoma that required intervention, or bleeding that required blood transfusion. Pulmonary vein ablation was performed in 355 patients (group 1=105, group 2=100, and group 3=150). More patients had spontaneous echocardiographic contrast in groups 1 and 2. One patient in group 1 had an ischemic stroke compared with 2 patients in group 2 and no patients in group 3. In group 1, 23 patients had minor bleeding, 9 had major bleeding, and 1 had pericardial effusion but no tamponade. In group 2, 19 patients had minor bleeding, and 2 patients developed symptomatic pericardial effusion with need for pericardiocentesis 1 week after discharge. In group 3, 8 patients developed minor bleeding, and 1 patient developed pericardial effusion with no tamponade. CONCLUSIONS - Continuation of warfarin throughout pulmonary vein ablation without administration of enoxaparin is safe and efficacious. This strategy can be an alternative to bridging with enoxaparin or heparin in the periprocedural period.

Original languageEnglish (US)
Pages (from-to)2531-2534
Number of pages4
JournalCirculation
Volume116
Issue number22
DOIs
StatePublished - Nov 2007
Externally publishedYes

Fingerprint

International Normalized Ratio
Atrial Fibrillation
Hemorrhage
Enoxaparin
Pericardial Effusion
Pulmonary Veins
Warfarin
Therapeutics
Hematoma
Pericardiocentesis
Cardiac Tamponade
Blood Transfusion
Heparin
Stroke

Keywords

  • Ablation
  • Atrium
  • Coagulation
  • Fibrillation

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Atrial fibrillation ablation in patients with therapeutic international normalized ratio : Comparison of strategies of anticoagulation management in the periprocedural period. / Wazni, Oussama M.; Beheiry, Salwa; Fahmy, Tamer; Barrett, Conor; Hao, Steven; Patel, Dimpi; Di Biase, Luigi; Martin, David O.; Kanj, Mohamed; Arruda, Mauricio; Cummings, Jennifer; Schweikert, Robert; Saliba, Walid; Natale, Andrea.

In: Circulation, Vol. 116, No. 22, 11.2007, p. 2531-2534.

Research output: Contribution to journalArticle

Wazni, OM, Beheiry, S, Fahmy, T, Barrett, C, Hao, S, Patel, D, Di Biase, L, Martin, DO, Kanj, M, Arruda, M, Cummings, J, Schweikert, R, Saliba, W & Natale, A 2007, 'Atrial fibrillation ablation in patients with therapeutic international normalized ratio: Comparison of strategies of anticoagulation management in the periprocedural period', Circulation, vol. 116, no. 22, pp. 2531-2534. https://doi.org/10.1161/CIRCULATIONAHA.107.727784
Wazni, Oussama M. ; Beheiry, Salwa ; Fahmy, Tamer ; Barrett, Conor ; Hao, Steven ; Patel, Dimpi ; Di Biase, Luigi ; Martin, David O. ; Kanj, Mohamed ; Arruda, Mauricio ; Cummings, Jennifer ; Schweikert, Robert ; Saliba, Walid ; Natale, Andrea. / Atrial fibrillation ablation in patients with therapeutic international normalized ratio : Comparison of strategies of anticoagulation management in the periprocedural period. In: Circulation. 2007 ; Vol. 116, No. 22. pp. 2531-2534.
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AU - Wazni, Oussama M.

AU - Beheiry, Salwa

AU - Fahmy, Tamer

AU - Barrett, Conor

AU - Hao, Steven

AU - Patel, Dimpi

AU - Di Biase, Luigi

AU - Martin, David O.

AU - Kanj, Mohamed

AU - Arruda, Mauricio

AU - Cummings, Jennifer

AU - Schweikert, Robert

AU - Saliba, Walid

AU - Natale, Andrea

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N2 - BACKGROUND - The best approach to management of anticoagulation before and after atrial fibrillation ablation is not known. METHODS AND RESULTS - We compared outcomes in consecutive patients undergoing pulmonary vein antrum isolation for persistent atrial fibrillation. Early in our practice, warfarin was stopped 3 days before ablation, and a transesophageal echocardiogram was performed to rule out clot. Enoxaparin, initially 1 mg/kg twice daily (group 1) and then 0.5 mg/kg twice daily (group 2), was used to "bridge" patients after ablation. Subsequently, warfarin was continued to maintain the international normalized ratio between 2 and 3.5 (group 3). Minor bleeding was defined as hematoma that did not require intervention. Major bleeding was defined as either cardiac tamponade, hematoma that required intervention, or bleeding that required blood transfusion. Pulmonary vein ablation was performed in 355 patients (group 1=105, group 2=100, and group 3=150). More patients had spontaneous echocardiographic contrast in groups 1 and 2. One patient in group 1 had an ischemic stroke compared with 2 patients in group 2 and no patients in group 3. In group 1, 23 patients had minor bleeding, 9 had major bleeding, and 1 had pericardial effusion but no tamponade. In group 2, 19 patients had minor bleeding, and 2 patients developed symptomatic pericardial effusion with need for pericardiocentesis 1 week after discharge. In group 3, 8 patients developed minor bleeding, and 1 patient developed pericardial effusion with no tamponade. CONCLUSIONS - Continuation of warfarin throughout pulmonary vein ablation without administration of enoxaparin is safe and efficacious. This strategy can be an alternative to bridging with enoxaparin or heparin in the periprocedural period.

AB - BACKGROUND - The best approach to management of anticoagulation before and after atrial fibrillation ablation is not known. METHODS AND RESULTS - We compared outcomes in consecutive patients undergoing pulmonary vein antrum isolation for persistent atrial fibrillation. Early in our practice, warfarin was stopped 3 days before ablation, and a transesophageal echocardiogram was performed to rule out clot. Enoxaparin, initially 1 mg/kg twice daily (group 1) and then 0.5 mg/kg twice daily (group 2), was used to "bridge" patients after ablation. Subsequently, warfarin was continued to maintain the international normalized ratio between 2 and 3.5 (group 3). Minor bleeding was defined as hematoma that did not require intervention. Major bleeding was defined as either cardiac tamponade, hematoma that required intervention, or bleeding that required blood transfusion. Pulmonary vein ablation was performed in 355 patients (group 1=105, group 2=100, and group 3=150). More patients had spontaneous echocardiographic contrast in groups 1 and 2. One patient in group 1 had an ischemic stroke compared with 2 patients in group 2 and no patients in group 3. In group 1, 23 patients had minor bleeding, 9 had major bleeding, and 1 had pericardial effusion but no tamponade. In group 2, 19 patients had minor bleeding, and 2 patients developed symptomatic pericardial effusion with need for pericardiocentesis 1 week after discharge. In group 3, 8 patients developed minor bleeding, and 1 patient developed pericardial effusion with no tamponade. CONCLUSIONS - Continuation of warfarin throughout pulmonary vein ablation without administration of enoxaparin is safe and efficacious. This strategy can be an alternative to bridging with enoxaparin or heparin in the periprocedural period.

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