Abstract 14307: Periprocedural Stokes and Anticoagulation Management During AF Ablation: Results From the “Compare" Randomized Multicenter Trial
Introduction: Iatrogenic periprocedural thromboembolic (TE) events are insidious complications of catheter ablation for atrial fibrillation (AF). We sought to determine whether the type of AF and the anticoagulation management with warfarin play a role in the reduction of periprocedural TE in a randomized multicenter study.
Methods: This was an open-label, randomized, parallel-group, multicenter study assessing the role of continuous warfarin in preventing periprocedural TE events after radio frequency catheter ablation. Patients with CHADS2 score < 1were excluded. Pts were randomly assigned to the off-warfarin or on-warfarin arm. In the current analysis we focused on whether pts with paroxysmal AF (PAF) were at a similar risk of TE events as those with persistent or long-standing persistent (LSP) AF.
Results: The study enrolled 1584 pts (429 PAF, 1155 non-paroxysmal AF (non-PAF); 790 pts were assigned to discontinue warfarin (group 1) and 794 pts to continuous warfarin (group 2). There were 39 TE [3.7% (29) strokes and 1.3% (10) TIA] events in group 1; 2 (0.8%) in PAF (paroxysmal), 5 (2.9%) in persistent AF, and 32 (8.2%) in LSP AF with a total of 37 TE events in non-PAF. Two (0.25%) strokes in LSP pts were observed in group 2 (p <0.001) with sub therapeutic INR the day of the procedure. When stratified by AF type, the event rate for stroke/TIA in PAF was 0.47% (2/429) compared to 3.2% in non-PAF (37/1155); p<0.001. The incidence of TE events were less likely in PAF pts compared to non-PAF group (relative risk 0.15, 95% CI 0.01 to 0.65, p <0.01). After adjusting for baseline covariates, the relative risk was 0.19 (95% CI 0.03 to 0.36, p = 0.02). At multivariate analysis, warfarin discontinuation was the strongest predictor of periprocedural TE (odds ratio (OR) 13, 95% CI 3.1 to 55.6 p<0.001).
Conclusions: This multicenter randomized study shows that in higher risk pts therapeutic INR protect against peri-procedural thromboembolic events. The risk of these complications during AF ablation is predominantly confined to pts with non paroxysmal AF. Therefore, future studies assessing the protecting value of newer anticoagulants should be performed in comparison with on warfarin treatment and enrolling pts with LSPAF since in paroxysmal pts these events are relatively rare.
- © 2013 by American Heart Association, Inc.