Abstract
Anticoagulation for Ablation of Atrial Fibrillation: Introduction: Appropriate activated clotting time (ACT) during catheter ablation of atrial fibrillation (CA-AF) is essential to minimize periprocedural complications. Methods and Results: An electronic search was performed using major databases. Outcomes were thromboembolic (TE) and bleeding complications according to ACT levels (seconds). Heparin dose (U/kg) and time (minutes) to achieve the target ACT was compared among patients receiving vitamin K antagonist (VKA) versus non-VKA oral anticoagulants (NOAC). Nineteen studies involving 7,150 patients were identified. Patients with ACT > 300 had less TE (OR, 0.51; 95% CI 0.35-0.74) and bleeding (OR, 0.70; 95% CI 0.60-0.83) compared to ACT <300, when using any type of oral anticoagulation. The use of VKA was associated with reduced heparin requirements (mean dose: 157 U/kg vs. 209 U/kg, P <0.03; SDM -0.86 [95% CI -1.39 to -0.33]), and with lower time to achieve the target ACT (mean time: 24 minutes vs. 49 minutes, P <0.03; SDM -11.02 [95% CI -13.29 to -8.75]) compared to NOACs. No significant publication bias was found. Conclusions: Performing CA-AF with a target ACT > 300 decreases the risk of TE without increasing the risk of bleeding. Patients receiving VKAs required less heparin and reached the target ACT faster compared to NOACs.
| Original language | English (US) |
|---|---|
| Journal | Journal of Cardiovascular Electrophysiology |
| DOIs | |
| State | Accepted/In press - 2016 |
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Keywords
- Atrial fibrillation
- Bleeding
- Catheter ablation
- Heparin
- Meta-analysis
- NOAC
- Stroke
- Vitamin K antagonist
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)
Cite this
Clinical Impact of Heparin Kinetics During Catheter Ablation of Atrial Fibrillation : Meta-Analysis and Meta-Regression. / Briceno, David F.; Villablanca, Pedro A.; Lupercio, Florentino; Kargoli, Faraj; Jagannath, Anand; Londono, Alejandra; Patel, Jignesh; Otusanya, Olufisayo; Brevik, Jeannine; Maraboto, Carola; Berardi, Cecilia; Krumerman, Andrew K.; Palma, Eugen C.; Kim, Soo G.; Natale, Andrea; Di Biase, Luigi.
In: Journal of Cardiovascular Electrophysiology, 2016.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Clinical Impact of Heparin Kinetics During Catheter Ablation of Atrial Fibrillation
T2 - Meta-Analysis and Meta-Regression
AU - Briceno, David F.
AU - Villablanca, Pedro A.
AU - Lupercio, Florentino
AU - Kargoli, Faraj
AU - Jagannath, Anand
AU - Londono, Alejandra
AU - Patel, Jignesh
AU - Otusanya, Olufisayo
AU - Brevik, Jeannine
AU - Maraboto, Carola
AU - Berardi, Cecilia
AU - Krumerman, Andrew K.
AU - Palma, Eugen C.
AU - Kim, Soo G.
AU - Natale, Andrea
AU - Di Biase, Luigi
PY - 2016
Y1 - 2016
N2 - Anticoagulation for Ablation of Atrial Fibrillation: Introduction: Appropriate activated clotting time (ACT) during catheter ablation of atrial fibrillation (CA-AF) is essential to minimize periprocedural complications. Methods and Results: An electronic search was performed using major databases. Outcomes were thromboembolic (TE) and bleeding complications according to ACT levels (seconds). Heparin dose (U/kg) and time (minutes) to achieve the target ACT was compared among patients receiving vitamin K antagonist (VKA) versus non-VKA oral anticoagulants (NOAC). Nineteen studies involving 7,150 patients were identified. Patients with ACT > 300 had less TE (OR, 0.51; 95% CI 0.35-0.74) and bleeding (OR, 0.70; 95% CI 0.60-0.83) compared to ACT <300, when using any type of oral anticoagulation. The use of VKA was associated with reduced heparin requirements (mean dose: 157 U/kg vs. 209 U/kg, P <0.03; SDM -0.86 [95% CI -1.39 to -0.33]), and with lower time to achieve the target ACT (mean time: 24 minutes vs. 49 minutes, P <0.03; SDM -11.02 [95% CI -13.29 to -8.75]) compared to NOACs. No significant publication bias was found. Conclusions: Performing CA-AF with a target ACT > 300 decreases the risk of TE without increasing the risk of bleeding. Patients receiving VKAs required less heparin and reached the target ACT faster compared to NOACs.
AB - Anticoagulation for Ablation of Atrial Fibrillation: Introduction: Appropriate activated clotting time (ACT) during catheter ablation of atrial fibrillation (CA-AF) is essential to minimize periprocedural complications. Methods and Results: An electronic search was performed using major databases. Outcomes were thromboembolic (TE) and bleeding complications according to ACT levels (seconds). Heparin dose (U/kg) and time (minutes) to achieve the target ACT was compared among patients receiving vitamin K antagonist (VKA) versus non-VKA oral anticoagulants (NOAC). Nineteen studies involving 7,150 patients were identified. Patients with ACT > 300 had less TE (OR, 0.51; 95% CI 0.35-0.74) and bleeding (OR, 0.70; 95% CI 0.60-0.83) compared to ACT <300, when using any type of oral anticoagulation. The use of VKA was associated with reduced heparin requirements (mean dose: 157 U/kg vs. 209 U/kg, P <0.03; SDM -0.86 [95% CI -1.39 to -0.33]), and with lower time to achieve the target ACT (mean time: 24 minutes vs. 49 minutes, P <0.03; SDM -11.02 [95% CI -13.29 to -8.75]) compared to NOACs. No significant publication bias was found. Conclusions: Performing CA-AF with a target ACT > 300 decreases the risk of TE without increasing the risk of bleeding. Patients receiving VKAs required less heparin and reached the target ACT faster compared to NOACs.
KW - Atrial fibrillation
KW - Bleeding
KW - Catheter ablation
KW - Heparin
KW - Meta-analysis
KW - NOAC
KW - Stroke
KW - Vitamin K antagonist
UR - http://www.scopus.com/inward/record.url?scp=84965142718&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84965142718&partnerID=8YFLogxK
U2 - 10.1111/jce.12975
DO - 10.1111/jce.12975
M3 - Article
C2 - 27004444
AN - SCOPUS:84965142718
JO - Journal of Cardiovascular Electrophysiology
JF - Journal of Cardiovascular Electrophysiology
SN - 1045-3873
ER -