Radiofrequency ablation of atrial fibrillation under therapeutic international normalized ratio

A safe and efficacious periprocedural anticoagulation strategy

Ayman A. Hussein, David O. Martin, Walid Saliba, Deven Patel, Saima Karim, Omar Batal, Mustafa Banna, Michelle Williams-Andrews, Minerva Sherman, Mohamed Kanj, Mandeep Bhargava, Thomas Dresing, Thomas Callahan, Patrick Tchou, Luigi Di Biase, Salwa Beheiry, Bruce Lindsay, Andrea Natale, Oussama Wazni

Research output: Contribution to journalArticle

135 Citations (Scopus)

Abstract

Background: The best periprocedural anticoagulation strategy at the time of pulmonary vein isolation (PVI) is not known. Most centers stop administering warfarin (Coumadin) and use bridging with heparin or enoxaparin. Objective: The purpose of this study was to evaluate the efficacy and safety of PVI under therapeutic international normalized ratio (INR). Methods: Between January 2005 and December 2008, PVI was performed in 3,052 patients with therapeutic INR (≥1.8) at the time of ablation. All patients were evaluated for ischemic strokes and bleeding complications. Results: Mean INR was 2.53 ± 0.62. Only 3 (0.098%) patients had ischemic strokes. One patient had a hemorrhagic stroke on the third day postablation but recovered completely by 1-week follow-up. Bleeding complications occurred in 34 (1.11%) patients; most were minor (0.79%). Major hemorrhagic complications occurred in 10 (0.33%) patients (tamponade in 5, hematomas requiring intervention in 2, transfusion necessary in 3). Conclusion: In a large patient population, continuation of Coumadin at a therapeutic INR at the time of PVI without use of heparin or enoxaparin for bridging is a safe and efficacious periprocedural anticoagulation strategy. It is an acceptable and potentially better alternative to strategies that use bridging with heparin or enoxaparin.

Original languageEnglish (US)
Pages (from-to)1425-1429
Number of pages5
JournalHeart Rhythm
Volume6
Issue number10
DOIs
StatePublished - Oct 2009
Externally publishedYes

Fingerprint

International Normalized Ratio
Atrial Fibrillation
Pulmonary Veins
Enoxaparin
Warfarin
Heparin
Stroke
Therapeutics
Hemorrhage
Hematoma
Safety
Population

Keywords

  • Ablation
  • Atrial fibrillation
  • Warfarin (Coumadin)

ASJC Scopus subject areas

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

Cite this

Radiofrequency ablation of atrial fibrillation under therapeutic international normalized ratio : A safe and efficacious periprocedural anticoagulation strategy. / Hussein, Ayman A.; Martin, David O.; Saliba, Walid; Patel, Deven; Karim, Saima; Batal, Omar; Banna, Mustafa; Williams-Andrews, Michelle; Sherman, Minerva; Kanj, Mohamed; Bhargava, Mandeep; Dresing, Thomas; Callahan, Thomas; Tchou, Patrick; Di Biase, Luigi; Beheiry, Salwa; Lindsay, Bruce; Natale, Andrea; Wazni, Oussama.

In: Heart Rhythm, Vol. 6, No. 10, 10.2009, p. 1425-1429.

Research output: Contribution to journalArticle

Hussein, AA, Martin, DO, Saliba, W, Patel, D, Karim, S, Batal, O, Banna, M, Williams-Andrews, M, Sherman, M, Kanj, M, Bhargava, M, Dresing, T, Callahan, T, Tchou, P, Di Biase, L, Beheiry, S, Lindsay, B, Natale, A & Wazni, O 2009, 'Radiofrequency ablation of atrial fibrillation under therapeutic international normalized ratio: A safe and efficacious periprocedural anticoagulation strategy', Heart Rhythm, vol. 6, no. 10, pp. 1425-1429. https://doi.org/10.1016/j.hrthm.2009.07.007
Hussein, Ayman A. ; Martin, David O. ; Saliba, Walid ; Patel, Deven ; Karim, Saima ; Batal, Omar ; Banna, Mustafa ; Williams-Andrews, Michelle ; Sherman, Minerva ; Kanj, Mohamed ; Bhargava, Mandeep ; Dresing, Thomas ; Callahan, Thomas ; Tchou, Patrick ; Di Biase, Luigi ; Beheiry, Salwa ; Lindsay, Bruce ; Natale, Andrea ; Wazni, Oussama. / Radiofrequency ablation of atrial fibrillation under therapeutic international normalized ratio : A safe and efficacious periprocedural anticoagulation strategy. In: Heart Rhythm. 2009 ; Vol. 6, No. 10. pp. 1425-1429.
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title = "Radiofrequency ablation of atrial fibrillation under therapeutic international normalized ratio: A safe and efficacious periprocedural anticoagulation strategy",
abstract = "Background: The best periprocedural anticoagulation strategy at the time of pulmonary vein isolation (PVI) is not known. Most centers stop administering warfarin (Coumadin) and use bridging with heparin or enoxaparin. Objective: The purpose of this study was to evaluate the efficacy and safety of PVI under therapeutic international normalized ratio (INR). Methods: Between January 2005 and December 2008, PVI was performed in 3,052 patients with therapeutic INR (≥1.8) at the time of ablation. All patients were evaluated for ischemic strokes and bleeding complications. Results: Mean INR was 2.53 ± 0.62. Only 3 (0.098{\%}) patients had ischemic strokes. One patient had a hemorrhagic stroke on the third day postablation but recovered completely by 1-week follow-up. Bleeding complications occurred in 34 (1.11{\%}) patients; most were minor (0.79{\%}). Major hemorrhagic complications occurred in 10 (0.33{\%}) patients (tamponade in 5, hematomas requiring intervention in 2, transfusion necessary in 3). Conclusion: In a large patient population, continuation of Coumadin at a therapeutic INR at the time of PVI without use of heparin or enoxaparin for bridging is a safe and efficacious periprocedural anticoagulation strategy. It is an acceptable and potentially better alternative to strategies that use bridging with heparin or enoxaparin.",
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T1 - Radiofrequency ablation of atrial fibrillation under therapeutic international normalized ratio

T2 - A safe and efficacious periprocedural anticoagulation strategy

AU - Hussein, Ayman A.

AU - Martin, David O.

AU - Saliba, Walid

AU - Patel, Deven

AU - Karim, Saima

AU - Batal, Omar

AU - Banna, Mustafa

AU - Williams-Andrews, Michelle

AU - Sherman, Minerva

AU - Kanj, Mohamed

AU - Bhargava, Mandeep

AU - Dresing, Thomas

AU - Callahan, Thomas

AU - Tchou, Patrick

AU - Di Biase, Luigi

AU - Beheiry, Salwa

AU - Lindsay, Bruce

AU - Natale, Andrea

AU - Wazni, Oussama

PY - 2009/10

Y1 - 2009/10

N2 - Background: The best periprocedural anticoagulation strategy at the time of pulmonary vein isolation (PVI) is not known. Most centers stop administering warfarin (Coumadin) and use bridging with heparin or enoxaparin. Objective: The purpose of this study was to evaluate the efficacy and safety of PVI under therapeutic international normalized ratio (INR). Methods: Between January 2005 and December 2008, PVI was performed in 3,052 patients with therapeutic INR (≥1.8) at the time of ablation. All patients were evaluated for ischemic strokes and bleeding complications. Results: Mean INR was 2.53 ± 0.62. Only 3 (0.098%) patients had ischemic strokes. One patient had a hemorrhagic stroke on the third day postablation but recovered completely by 1-week follow-up. Bleeding complications occurred in 34 (1.11%) patients; most were minor (0.79%). Major hemorrhagic complications occurred in 10 (0.33%) patients (tamponade in 5, hematomas requiring intervention in 2, transfusion necessary in 3). Conclusion: In a large patient population, continuation of Coumadin at a therapeutic INR at the time of PVI without use of heparin or enoxaparin for bridging is a safe and efficacious periprocedural anticoagulation strategy. It is an acceptable and potentially better alternative to strategies that use bridging with heparin or enoxaparin.

AB - Background: The best periprocedural anticoagulation strategy at the time of pulmonary vein isolation (PVI) is not known. Most centers stop administering warfarin (Coumadin) and use bridging with heparin or enoxaparin. Objective: The purpose of this study was to evaluate the efficacy and safety of PVI under therapeutic international normalized ratio (INR). Methods: Between January 2005 and December 2008, PVI was performed in 3,052 patients with therapeutic INR (≥1.8) at the time of ablation. All patients were evaluated for ischemic strokes and bleeding complications. Results: Mean INR was 2.53 ± 0.62. Only 3 (0.098%) patients had ischemic strokes. One patient had a hemorrhagic stroke on the third day postablation but recovered completely by 1-week follow-up. Bleeding complications occurred in 34 (1.11%) patients; most were minor (0.79%). Major hemorrhagic complications occurred in 10 (0.33%) patients (tamponade in 5, hematomas requiring intervention in 2, transfusion necessary in 3). Conclusion: In a large patient population, continuation of Coumadin at a therapeutic INR at the time of PVI without use of heparin or enoxaparin for bridging is a safe and efficacious periprocedural anticoagulation strategy. It is an acceptable and potentially better alternative to strategies that use bridging with heparin or enoxaparin.

KW - Ablation

KW - Atrial fibrillation

KW - Warfarin (Coumadin)

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SN - 1547-5271

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