Abstract 19354: Higher Amount of Heparin Use is a Potential Independent Risk Factor for Cardiac Tamponade and Pericardial Effusion in the Periprocedural Period of Catheter Ablation for Atrial Fibrillation With DOACs Treatment
Introduction: Recent studies have indicated that direct oral anticoagulants (DOACs) were equivalent to uninterruped vitamin K antagonist (VKA) for preventing thromboembolism and bleeding during the periprocedural period of radiofrequency catheter ablation (RFA) for atrial fibrillation (AF). However, the risk factor for cardiac tamponade and pericardial effusion during AF ablation with DOACs treatment remains to be elucidated.
Methods: We included 379 consecutive patients who underwent RFA for AF between January 2012 and April 2016. All patients were administered DOACs (Dabigatran: n = 110 [29%]; Rivaroxaban: n = 173 [45.6%]; Apixaban: n = 96 [25.3%]) in the periprocedural period. During RFA, activated clotting time was maintained for about 300-350 seconds. Patients were divided into two groups: those with subsequent cardiac tamponade or pericardial effusion (group 1, n=11) and those without (group 2, n=368). Clinical indices including amounts of heparin use, HAS-BLED scores were compared between two groups.
Results: Cardiac tamponade and pericardial effusion were seen in 11 (2.9%) out of 379 patients. The event rate did not differ among three oral anticoagulants (Dabigatran 0.9% vs. Rivaroxaban 2.3% vs. Apixaban 6.2%; P=0.09). The mean amounts of heparin use was significantly higher in group 1 than in group 2 (median 326±61 U/kg vs. 264± 88 U/kg; P=0.02). Using HAS-BLED score-adjusted logistic regression analysis, the odds ratio for the amounts of heparin use was 1.01 (95% CI 1.00-1.01; P=0.03). The best cutoff value for the amounts of heparin use was 244 U/kg (ROC AUC 0.76, 95% CI 0.67 to 0.86).
Conclusions: This study demonstrated that higher amount of heparin use is a potential independent risk factor for cardiac tamponade and pericardial effusion in the periprocedural period of RFA for AF with DOACs treatment.
Author Disclosures: T. Kinoshita: None. T. Fujino: None. M. Shinohara: None. H. Koike: None. H. Yuzawa: None. T. Suzuki: None. H. Hideyuki: None. S. Fukunaga: None. S. Fukunaga: None. K. Kobayashi: None. T. Ikeda: None.
- © 2016 by American Heart Association, Inc.