Clinical Impact of Heparin Kinetics During Catheter Ablation of Atrial Fibrillation

Meta-Analysis and Meta-Regression

David F. Briceno, Pedro A. Villablanca, Florentino Lupercio, Faraj Kargoli, Anand Jagannath, Alejandra Londono, Jignesh Patel, Olufisayo Otusanya, Jeannine Brevik, Carola Maraboto, Cecilia Berardi, Andrew K. Krumerman, Eugen C. Palma, Soo G. Kim, Andrea Natale, Luigi Di Biase

Research output: Contribution to journalArticle

21 Citations (Scopus)

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 languageEnglish (US)
JournalJournal of Cardiovascular Electrophysiology
DOIs
StateAccepted/In press - 2016

Fingerprint

Catheter Ablation
Atrial Fibrillation
Heparin
Meta-Analysis
Hemorrhage
Vitamin K
Anticoagulants
Databases

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 journalArticle

Briceno, DF, Villablanca, PA, Lupercio, F, Kargoli, F, Jagannath, A, Londono, A, Patel, J, Otusanya, O, Brevik, J, Maraboto, C, Berardi, C, Krumerman, AK, Palma, EC, Kim, SG, Natale, A & Di Biase, L 2016, 'Clinical Impact of Heparin Kinetics During Catheter Ablation of Atrial Fibrillation: Meta-Analysis and Meta-Regression', Journal of Cardiovascular Electrophysiology. https://doi.org/10.1111/jce.12975
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. / Clinical Impact of Heparin Kinetics During Catheter Ablation of Atrial Fibrillation : Meta-Analysis and Meta-Regression. In: Journal of Cardiovascular Electrophysiology. 2016.
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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.",
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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

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