Abstract 13316: Catheter Ablation of Atrial Fibrillation Under “Therapeutic Coumadin”: Prevalence of Pericardial Effusion Comparing Paroxysmal and Non Paroxysmal Atrial Fibrillation
Introduction: Catheter ablation of atrial fibrillation without discontinuation of Warfarin at the time of the procedure has been proposed with satisfactory results.
Objective; The aim of our study was to compare the incidence of major peri-procedural bleeding complications such as pericardial effusion/tamponade with the type of AF.
Methods: This study included 6549 [2442 (37%) PAF, 1334 (21%) persistent, 2773 (42%) LSP] consecutive patients referred for AF ablation. All patients had ‘therapeutic” INR the day of the procedure and for the 3 weeks preceding the procedure. Patients were divided into non-LSP (n=3776, 59±14 years, 72% male) and LSP (n=2773, 60±11 years, 76% male) groups. Minor bleeding was defined as hematoma that did not require intervention. Major bleeding was defined as cardiac tamponade or hematoma that required intervention.
Results: Clinical characteristics including CHADS2 score and history of prior stroke/TIA were identically distributed across the groups, except for LA size. The LSP group had larger LA (47.1±8 versus 43.6±7mm, p<0.001). In the non-LSP group 111 (3%) patients had minor bleeding complications compared to 148 (5%) in the LSP (p<0.001). Risk of major bleeding did not vary significantly between the groups [13(0.3%) patients in non-LSP and 18(0.6%) in LSP patients (p=0.219)]. In the LSP group, 22 (0.8%) patients developed pericardial effusion while in the non-LSP population 10 (0.3%) patients developed pericardial effusion (p=0.008). All patients with pericardial effusion required pericardiocentesis and were given protamine and fresh frozen plasma to reverse heparin and the warfarin effect respectively. One patients required surgery.
Conclusions: Pericardial effusion during AF ablation with therapeutic INR is more common in patients undergoing ablation for LSP atrial fibrillation. Figure: Odds ratio for peri-procedural bleeding complications
- © 2011 by American Heart Association, Inc.