Radiofrequency ablation of atrial fibrillation under therapeutic international normalized ratio: a safe and efficacious periprocedural anticoagulation strategy.
BACKGROUND
The best periprocedural anticoagulation strategy at the time of pulmonary vein isolation (PVI) is not known. Most centers stop administering warfarin (Coumadin) and use bridging with heparin or enoxaparin.


OBJECTIVE
The purpose of this study was to evaluate the efficacy and safety of PVI under therapeutic international normalized ratio (INR).


METHODS
Between January 2005 and December 2008, PVI was performed in 3,052 patients with therapeutic INR (> or =1.8) at the time of ablation. All patients were evaluated for ischemic strokes and bleeding complications.


RESULTS
Mean INR was 2.53 +/- 0.62. Only 3 (0.098%) patients had ischemic strokes. One patient had a hemorrhagic stroke on the third day postablation but recovered completely by 1-week follow-up. Bleeding complications occurred in 34 (1.11%) patients; most were minor (0.79%). Major hemorrhagic complications occurred in 10 (0.33%) patients (tamponade in 5, hematomas requiring intervention in 2, transfusion necessary in 3).


CONCLUSIONS
In a large patient population, continuation of Coumadin at a therapeutic INR at the 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 better alternative to strategies that use bridging with heparin or enoxaparin.
Hussein
Ayman A
AA
Center for Atrial Fibrillation, Cleveland Clinic, Cleveland, OH, USA.
Martin
David O
DO
Saliba
Walid
W
Patel
Deven
D
Karim
Saima
S
Batal
Omar
O
Banna
Mustafa
M
Williams-Andrews
Michelle
M
Sherman
Minerva
M
Kanj
Mohamed
M
Bhargava
Mandeep
M
Dresing
Thomas
T
Callahan
Thomas
T
Tchou
Patrick
P
Di Biase
Luigi
L
Beheiry
Salwa
S
Lindsay
Bruce
B
Natale
Andrea
A
Wazni
Oussama
O
D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011667:Pulmonary Veins / Q000601:surgery; D020521:Stroke / Q000139:chemically induced; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
D000925:Anticoagulants; D014859:Warfarin