Nationwide survey of catheter ablation for atrial fibrillation: The Japanese catheter ablation registry of atrial fibrillation (J-CARAF)-A report on periprocedural oral anticoagulants.
BACKGROUND
Catheter ablation has become an established therapy for the treatment of atrial fibrillation (AF). To obtain a perspective on the current status of this therapy in Japan, the Japanese Heart Rhythm Society (JHRS) conducted a nationwide survey, the Japanese Catheter Ablation Registry of Atrial Fibrillation (J-CARAF). In this study, we focused on whether periprocedural use of novel oral anticoagulants (NOACs) was related with excessive thromboembolic or bleeding complications.


METHODS
Using an online questionnaire, JHRS requested electrophysiology centers in Japan to register the data of patients who underwent AF ablations in September 2011, March 2012, and September 2012. We compared the clinical profiles and ablation data, including the incidence of complications among patients in whom warfarin, a NOAC or neither was used as a periprocedural anticoagulant.


RESULTS
A total of 179 centers submitted data relating to 3373 patients (62.2±10.6 years). Paroxysmal atrial fibrillation (PAF) was observed in 64.4% of patients. Warfarin, as a periprocedural oral anticoagulant, was used by 53.6% (1808/3373) of patients. A NOAC was given to 541 subjects (dabigatran: 504 [16.1%], rivaroxaban: 37 [1.1%]). In the remaining 1024 patients (30.4%), no periprocedural oral anticoagulants (OACs) were used. The proportion of PAF in warfarin-treated patients (61.1%) was significantly lower than that in NOAC-treated patients (70.1%, p<0.01) or in patients not treated with an OAC (67.4%, p<0.01). Patients treated with uninterrupted warfarin therapy were associated with significantly higher CHA2DS2-VASc scores. A total of 158 complications occurred in 151 subjects (4.5%). The incidence of complications in NOAC-treated patients (14/541 [2.6%]) was lower than that in patients receiving uninterrupted warfarin therapy (4.8%, p<0.05). The incidence of pericardial effusion in NOAC-treated patients (0.7%) was lower than in warfarin-treated patients (2.6%, p<0.05). The difference in the periprocedural anticoagulant strategy was not related to the frequency of other bleeding events. Cerebral infarction occurred in one patient from each patient group.


CONCLUSIONS
Our results suggest that NOACs are safe for use as substitutes for warfarin without causing excessive increases in the rates of thromboembolic or bleeding complications.
Fourth Department of Internal Medicine, Teikyo University School of Medicine, 3-8-3 Mizonokuchi, Takatsu-ku, Kawasaki, Kanagawa 213-8507, Japan.
Yuji
Y
Murakawa
Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan.
Akihiko
A
Nogami
Department of Cardiology, Tokyo Women׳s Medical University, Japan.
Morio
M
Shoda
Cardiovascular Center, Sakurabashi Watanabe Hospital, Japan.
Koichi
K
Inoue
Division of Cardiology, Gunma Prefectural Cardiovascular Center, Japan.
Shigeto
S
Naito
Heart Rhythm Center, Fukuoka Sanno Hospital, Japan.
Koichiro
K
Kumagai
Division of Cardiology, Nippon Medical School, Japan.
Yasushi
Y
Miyauchi
Department of Cardiology, Jikei University School of Medicine, Japan.
Teiichi
T
Yamane
Division of Cardiology, Tokai University Hachioji Hospital, Japan.
Norishige
N
Morita
Division of Cardiology, Tachikawa Hospital, Japan.
Hideo
H
Mitamura
Division of Cardiology, Hirosaki University Graduate School of Medicine, Japan.
Ken
K
Okumura
Atrial fibrillation; Catheter ablation; Dabigatran; Warfarin