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 journalArticlepeer-review

143 Scopus citations

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 1 2009
Externally publishedYes

Keywords

  • Ablation
  • Atrial fibrillation
  • Warfarin (Coumadin)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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