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Observational Study
. 2014 Jun;37(6):665-73.
doi: 10.1111/pace.12401. Epub 2014 May 4.

Comparative safety of periablation anticoagulation strategies for atrial fibrillation: data from a large multicenter study

Aysha Arshad  1 , Christopher K Johnson, Suneet Mittal, Eric Buch, Ismail Hamam, Thanh Tran, Richard E Shaw, Dan Musat, Mark Preminger, Tina Sichrovsky, Bengt Herweg, Kalyanam Shivkumar, John Hummel, Jonathan S Steinberg
Affiliations
Observational Study

Comparative safety of periablation anticoagulation strategies for atrial fibrillation: data from a large multicenter study

Aysha Arshad et al. Pacing Clin Electrophysiol. 2014 Jun.

Abstract

Background: There are a variety of periprocedural anticoagulation strategies for atrial fibrillation (AF) ablation, including the use of dabigatran. It is unclear which strategy is superior.

Objective: To compare the safety and efficacy of anticoagulation with uninterrupted warfarin, dabigatran, and warfarin with heparin bridging in patients undergoing ablation of AF at four experienced centers.

Methods and results: In this retrospective analysis, 882 patients (mean age: 61 ± 11 years) underwent ablation of AF using uninterrupted warfarin (n = 276), dabigatran (n = 374), or warfarin with heparin bridging (n = 232) for periprocedural anticoagulation. The rate of total complications was 23/276 (8.3%) in the uninterrupted warfarin group, 30/374 (8.0%) in the dabigatran group, and 29/232 (12.5%) in the bridged group (P = 0.15). Major complications were more frequent in the uninterrupted warfarin group 12/276 (4.3%) compared with 3/374 (0.8%) in dabigatran and 6/232 (2.6%) in the bridged group (P = 0.01). The most common major complication was the need for transfusion or occurrence of major bleeding. Minor complications did not differ among the three groups. On multivariate analysis, female gender (odds ratio [OR] 1.93, confidence interval [CI] 1.16-3.19, P = 0.011), bridging heparin (OR 2.13, CI 1.100-3.941, P = 0.016), use of triple antithrombotic therapy (OR 1.77, CI 1.05-2.98, P = 0.033), and prior myocardial infarction (OR 2.40, CI 1.01-5.67, P = 0.046) independently predicted total complications.

Conclusions: When comparing the use of uninterrupted warfarin, dabigatran, and warfarin with heparin bridging in patients undergoing catheter ablation of AF, dabigatran was not associated with increased risk, major complications were more common in the uninterrupted warfarin group, and after adjustment, warfarin with bridging increased total complications.

Keywords: ablation; atrial fibrillation; pharmacology.

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Figures

Figure 1
Figure 1
Incidence of major complications comparing anticoagulation strategies.
Figure 2
Figure 2
Incidence of minor complications comparing anticoagulation strategies.
See this image and copyright information in PMC

Comment in

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