title: Clinical Impact of Heparin Kinetics During Catheter Ablation of Atrial Fibrillation: Meta-Analysis and Meta-Regression.
abstract: Appropriate activated clotting time (ACT) during catheter ablation of atrial fibrillation (CA-AF) is essential to minimize periprocedural complications.
  
  
  
  An electronic search was performed using major databases. Outcomes were thromboembolic (TE) and bleeding complications according to ACT levels (seconds). Heparin dose (U/kg) and time (minutes) to achieve the target ACT was compared among patients receiving vitamin K antagonist (VKA) versus non-VKA oral anticoagulants (NOAC). Nineteen studies involving 7,150 patients were identified. Patients with ACT > 300 had less TE (OR, 0.51; 95% CI 0.35-0.74) and bleeding (OR, 0.70; 95% CI 0.60-0.83) compared to ACT < 300, when using any type of oral anticoagulation. The use of VKA was associated with reduced heparin requirements (mean dose: 157 U/kg vs. 209 U/kg, P < 0.03; SDM -0.86 [95% CI -1.39 to -0.33]), and with lower time to achieve the target ACT (mean time: 24 minutes vs. 49 minutes, P < 0.03; SDM -11.02 [95% CI -13.29 to -8.75]) compared to NOACs. No significant publication bias was found.
  
  
  
  Performing CA-AF with a target ACT > 300 decreases the risk of TE without increasing the risk of bleeding. Patients receiving VKAs required less heparin and reached the target ACT faster compared to NOACs.
authors.affiliation: Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Briceno
authors.affiliation: Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Villablanca
authors.affiliation: Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
authors.forename: Florentino
authors.initials: F
authors.lastname: Lupercio
authors.affiliation: Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
authors.forename: Faraj
authors.initials: F
authors.lastname: Kargoli
authors.affiliation: Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
authors.forename: Anand
authors.initials: A
authors.lastname: Jagannath
authors.affiliation: Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Londono
authors.affiliation: Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
authors.forename: Jignesh
authors.initials: J
authors.lastname: Patel
authors.affiliation: Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
authors.forename: Olufisayo
authors.initials: O
authors.lastname: Otusanya
authors.affiliation: Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
authors.forename: Jeannine
authors.initials: J
authors.lastname: Brevik
authors.affiliation: Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
authors.forename: Carola
authors.initials: C
authors.lastname: Maraboto
authors.affiliation: Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Berardi
authors.affiliation: Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Krumerman
authors.affiliation: Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
authors.forename: Eugen
authors.initials: E
authors.lastname: Palma
authors.affiliation: Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
authors.forename: Soo G
authors.initials: SG
authors.lastname: Kim
authors.affiliation: Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.|Department of Biomedical Engineering, University of Texas, Austin, Texas, USA.|Division of Cardiology, Stanford University, Palo Alto, California, USA.|Case Western Reserve University, Cleveland, Ohio, USA.|Scripps Clinic, San Diego, California, USA.|Dell Medical School, Austin, Texas, USA.|California Pacific Medical Center, San Francisco, California, USA.|Department of Cardiology, University of Foggia, Foggia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.affiliation: Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA.|Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.|Department of Biomedical Engineering, University of Texas, Austin, Texas, USA.|Department of Cardiology, University of Foggia, Foggia, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: DI Biase
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000493:pharmacokinetics*; D001281:Atrial Fibrillation / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001777:Blood Coagulation / Q000187:drug effects*; D017115:Catheter Ablation; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000008:administration & dosage / Q000493:pharmacokinetics*; D006801:Humans; D016017:Odds Ratio; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D014812:Vitamin K; D006493:Heparin
keywords: NOAC; atrial fibrillation; bleeding; catheter ablation; heparin; meta-analysis; stroke; vitamin K antagonist