title: Catheter ablation of atrial fibrillation in patients with therapeutic oral anticoagulation treatment.
abstract: OBJECTIVE
  Current guidelines recommend discontinuation of oral anticoagulation treatment (OAT) and switch to heparin 2-5 days before catheter ablation of atrial fibrillation (AF). However, increasing evidence leans against the 'bridge therapy' and support continuation of OAT during the procedure.
  
  
  RESULTS
  We evaluated the safety of AF ablation among patients with therapeutic OAT. The study population comprised 193 consecutive patients who underwent 228 AF ablation procedures guided by electroanatomical mapping. Periprocedural international normalized ratio was <2 (1.6 ± 0.3) in 103 cases (Group 1) and ≥2 (2.4 ± 0.4) in 125 cases (Group 2). Heparin (5000 IU bolus followed by continuous infusion through an open-irrigated ablation catheter) was used in both groups. No intracardiac echocardiographic guidance was used and activated clotting time (ACT) was not monitored. The incidence of major (intracranial bleeding, tamponade, bleeding that required surgical intervention, or blood transfusion) and minor bleeding complications and all thrombo-embolic events were registered during the 3-month follow-up. There was no statistical difference in major (P = 1.0) and minor complications (P = 0.74) between the groups. The bleeding complications included one surgically corrected groin haematoma in both groups (0.9%), 25 small haematomas at the puncture site (11 in Group 1 (10.7%) and 14 in Group 2 (11.2%), P = 0.90), and two minor pericardial effusions in Group 1. In Group 2, one patient had ischaemic stroke 16 days after the procedure.
  
  
  CONCLUSIONS
  Transseptal puncture and AF ablation can be performed safely in patients with ongoing OAT without intracardiac echocardiographic guidance and ACT monitoring.
authors.affiliation: Department of Internal Medicine, University of Oulu, Oulu, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Hakalahti
authors.forename: Paavo
authors.initials: P
authors.lastname: Uusimaa
authors.forename: Kari
authors.initials: K
authors.lastname: Ylitalo
authors.forename: M J Pekka
authors.initials: MJ
authors.lastname: Raatikainen
mesh_terms: D000284:Administration, Oral; 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; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000139:chemically induced / Q000517:prevention & control*; D013927:Thrombosis / Q000517:prevention & control*; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin