title: Early Experience of Novel Oral Anticoagulants in Catheter Ablation for Atrial Fibrillation: Efficacy and Safety Comparison to Warfarin.
abstract: OBJECTIVE
  Compared with warfarin, novel oral anticoagulants (NOACs) are convenient to use, although they require a blanking period immediately before radiofrequency catheter ablation for atrial fibrillation (AF). We compared NOACs and uninterrupted warfarin in the peri-procedural period of AF ablation.
  
  
  METHODS
  We compared 141 patients treated with peri-procedural NOACs (72% men; 58 ± 11 years old; 71% with paroxysmal AF) and 281 age-, sex-, AF type-, and history of stroke-matched patients treated with uninterrupted warfarin. NOACs were stopped 24 hours before the procedure and restarted on the same procedure day after hemostasis was achieved.
  
  
  RESULTS
  We found no difference in the CHA₂DS₂-VASc (p=0.376) and HAS-BLED scores (p=0.175) between the groups. The preprocedural anticoagulation duration was significantly shorter in the NOAC group (76.3 ± 110.7 days) than in the warfarin group (274.7 ± 582.7 days, p<0.001). The intra-procedural total heparin requirement was higher (p<0.001), although mean activated clotting time was shorter (350.0 ± 25.0 s vs. 367.4 ± 42.9 s, p<0.001), in the NOAC group than in the warfarin group. There was no significant difference in thromboembolic events (1.4% vs. 0%, p=0.111) or major bleeding (1.4% vs. 3.9%, p=0.235) between the NOAC and warfarin groups. Minor stroke occurred in two cases within 10 hours of the procedure (underlying CHA₂DS₂-VASc scores 0 and 1) in the NOAC group.
  
  
  CONCLUSIONS
  Pre-procedural anticoagulation duration was shorter and intra-procedural heparin requirement was higher with NOAC than with uninterrupted warfarin during AF ablation. Although the peri-procedural thromboembolism and bleeding incidences did not differ, minor stroke occurred in two cases in the NOAC group.
authors: Department of Cardiology, Yonsei University Health System, Seoul, Korea.
authors: Dong Geum
authors: DG
authors: Shin
authors: Department of Cardiology, Yonsei University Health System, Seoul, Korea.
authors: Tae Hoon
authors: TH
authors: Kim
authors: Department of Cardiology, Yonsei University Health System, Seoul, Korea.
authors: Jae Sun
authors: JS
authors: Uhm
authors: Department of Cardiology, Yonsei University Health System, Seoul, Korea.
authors: Joung Youn
authors: JY
authors: Kim
authors: Department of Cardiology, Yonsei University Health System, Seoul, Korea.
authors: Boyoung
authors: B
authors: Joung
authors: Department of Cardiology, Yonsei University Health System, Seoul, Korea.
authors: Moon Hyoung
authors: MH
authors: Lee
authors: Department of Cardiology, Yonsei University Health System, Seoul, Korea. hnpak@yuhs.ac.
authors: Hui Nam
authors: HN
authors: Pak
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000453:epidemiology; D006493:Heparin; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology; D013923:Thromboembolism / Q000453:epidemiology; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin
keywords: Atrial fibrillation; catheter ablation; novel oral anticoagulant; warfarin