Periprocedural anticoagulation for atrial fibrillation ablation.
BACKGROUND
Catheter ablation for atrial fibrillation (AF) can increase risk of left atrial (LA) thrombi and stroke. Optimal periprocedural anticoagulation has not been determined.


OBJECTIVE
We report the role of administering warfarin and aspirin without low molecular weight heparin in patients undergoing AF ablation.


METHODS
A total of 207 patients underwent ablation for AF. Transesophageal echocardiography (TEE) guided transseptal puncture and ruled out clot in the LA. After first puncture, the sheath was flushed with heparin (5,000 Units/mL). After second puncture, a bolus of 80 units/kg of heparin was given, followed by an infusion to maintain activated clotting time (ACT) around 300-350 seconds. Warfarin was stopped and aspirin was started (325 mg/day) 3 days preprocedure. Warfarin was restarted on the day of the procedure. Both medications were continued for 6 weeks postablation. Warfarin was continued for 6 months in patients with prior history of persistent or recurrent AF. Thirty-seven patients who showed smoke in the LA on TEE were given low molecular weight heparin postprocedure until international normalized ratio (INR) was therapeutic.


RESULTS
Thirty-two patients had persistent and 175 had paroxysmal AF; 87 were cardioverted during ablation. Two patients had transient ischemic attack (TIA) on the sixth and eighth days, respectively, following ablation, with complete recovery. Both had subtherapeutic INRs.


CONCLUSIONS
In patients without demonstrable clot or smoke in the LA, starting aspirin 3 days prior and warfarin immediately post-radiofrequency ablation, without low molecular weight heparin, with meticulous anticoagulation during the procedure, appears to be a safe mode of anticoagulation.
Mortada
M Eyman
ME
Electrophysiology Laboratories of Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health-Milwaukee Clinical Campus, Milwaukee, Wisconsin 53215, USA.
Chandrasekaran
K
K
Nangia
Vikram
V
Dhala
Anwer
A
Blanck
Zalmen
Z
Cooley
Ryan
R
Bhatia
Atul
A
Gilbert
Carol
C
Akhtar
Masood
M
Sra
Jasbir
J
D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007430:Intraoperative Care / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011292:Premedication / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology* / Q000517:prevention & control*; D014922:Wisconsin / Q000453:epidemiology
D000925:Anticoagulants