Atrial Fibrillation Ablation in Patients with Therapeutic International Normalized Ratios

Abstract

Atrial fibrillation ablation in patients with therapeutic INR on the day of a procedure appears to be safe and feasible. Expensive outpatient anti-coagulation bridging may be safely avoided in this type of population.

Ablation of Atrial Fibrillation Under Therapeutic Warfarin Reduces Periprocedural Complications

“…13 A fixed-effects model of analysis was adopted in the absence of statistical heterogeneity, whereas a random-effects model was preferred in cases of substantial heterogeneity. Sensitivity analyses were conducted as follows: withdrawing 1 study at a time, withdrawing studies in which preprocedural bridging with low-molecular-weight heparin in the DW group was not required, 6,11,14 withdrawing low-quality studies, 6,8,11,14 and withdrawing the study in which an indirect comparison analysis with the Worldwide Survey population was performed. 2,7 Subgroup analyses were carried out to appraise the impact of baseline patient characteristics (age, sex, average CHADS 2 [congestive heart failure, hypertension, age Ն75 years, diabetes mellitus, prior stroke or TIA] score, type of AF, and left atrial diameter), procedural data and different intraprocedural anticoagulation strategies (ie, use of open-irrigation catheters, ablation techniques, administering unfractionated heparin bolus before or after the transseptal puncture, different heparin doses or target activated clotting times), and of intracardiac echography (ICE) monitoring on periprocedural complications.…”

“…Intravenous unfractionated heparin was administered in all patients, although with different doses and at different stages of the procedure (Table 2). ICE was used in 5 studies, 4,5,7,10,14 and irrigated ablation catheters were used in all but 2 studies. 6,10 The definition of thromboembolic complication was quite consistent among the included studies and basically was the composite of ischemic stroke and TIA.…”

Impact of International Normalized Ratio and Activated Clotting Time on Unfractionated Heparin Dosing During Ablation of Atrial Fibrillation

“…6,7 Multiple studies have shown that it is safe and effective to continue warfarin at therapeutic levels before, during, and after the procedure. [7][8][9][10] Although this approach seems to decrease the amount of heparin required to achieve an adequate ACT, it remains a challenge to achieve an acceptable ACT with a single bolus of unfractionated heparin (UFH). The main purpose of this study was to assess the factors that affect the amount of UFH needed to achieve a therapeutic ACT ≥300 seconds.…”

Ablation Versus Drugs: What Is the Best First-Line Therapy for Paroxysmal Atrial Fibrillation?

“…Evidence that intraprocedural intracardiac echocardiography (ICE) reduces major bleeding complications when ablation is performed on therapeutic warfarin. 33,[37][38][39][40][41][42][43][44] Adapted from Santangeli et al 32 with permission of the publisher. Copyright © 2012, American Heart Association.…”