Abstract 2318: Radiofrequency Ablation of Atrial Fibrillation Under Therapeutic International Normalized Ratio: A Safe and Efficacious Periprocedural Anticoagulation Strategy
Background and Objectives: The best periprocedural anticoagulation strategy at time of pulmonary vein isolation (PVI) is not known. The aim of our study was to evaluate the efficacy and safety of PVI under therapeutic international normalized ratio (INR) without use of heparin or enoxaparin.
Methods: PVI was performed in 3052 patients between January 2005 and December 2008 with a therapeutic INR (≥1.8) at time of ablation. All patients were evaluated for complications related to the procedure (thromboembolic and hemorrhagic complications), on day of ablation and subsequent follow-ups up to 4 months after PVI.
Results: The mean INR was 2.53±0.62. Only 3 patients (0.098%) had ischemic strokes (reversible in 2 of them). One patient (0.03%) had a hemorrhagic stroke with complete recovery at 1 week follow-up. Bleeding complications occurred in 34 patients (1.11%). Most were minor (24 patients, 0.78%: 20 hematomas that did not require intervention and 4 pericardial effusions that did not require pericardiocentesis). Major hemorrhagic complications occurred in 10 patients (0.32%, 5 tamponades, 2 hematomas requiring intervention, 3 patients required transfusion for retroperitoneal bleeding (1 patient), post PVI drop in hemoglobin (1 patient) and vascular laceration (1 patient). INRs were similar in patients with and without hemorrhagic complications (2.64±0.78 vs. 2.53±0.62, p=0.78). No patients developed deep venous thrombosis, hemoptysis or hemothorax.
Conclusion: In a large patient population, continuation of warfarin at a therapeutic INR at 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 a better alternative to strategies using bridging with heparin or enoxaparin.