title: Influence of periprocedural anticoagulation strategies on complication rate and hospital stay in patients undergoing catheter ablation for persistent atrial fibrillation.
abstract: BACKGROUND
  The use of non-vitamin K antagonists (NOACs), uninterrupted (uVKA) and interrupted vitamin K antagonists (iVKA) are common periprocedural oral anticoagulation (OAC) strategies for atrial fibrillation (AF) ablation. Comparative data on complication rates resulting from OAC strategies for solely persistent AF (persAF) undergoing ablation are sparse. Thus, we sought to determine the impact of these OAC strategies on complication rates among patients with persAF undergoing catheter ablation.
  
  
  METHODS
  Consecutive patients undergoing persAF ablation were included. Depending on preprocedural OAC, three groups were defined: (1) NOACs (paused 48 h preablation), (2) uVKA, and (3) iVKA with heparin bridging. A combined complication endpoint (CCE) composed of bleeding and thromboembolic events was analyzed.
  
  
  RESULTS
  Between 2011 and 2014, 1440 persAF ablation procedures were performed in 1092 patients. NOACs were given in 441 procedures (31 %; rivaroxaban 57 %, dabigatran 33 %, and apixaban 10 %), uVKA in 488 (34 %), and iVKA in 511 (35 %). Adjusted CCE rates were 5.5 % [95 % confidence interval (CI) (3.1-7.8)] in group 1 (NOACs), 7.5 % [95 % CI (5.0-10.1)] in group 2 (uVKA), and 9.9 % [95 % CI (6.6-13.2)] in group 3. Compared to group 1, the combined complication risk was almost twice as high in group 3 [odd's ratio (OR) 1.9, 95 % CI (1.0-3.7), p = 0.049)]. The major complication rate was low (0.9 %). Bleeding complications, driven by minor groin complications, are more frequent than thromboembolic events (n = 112 vs. 1, p < 0.0001).
  
  
  CONCLUSIONS
  Patients undergoing persAF ablation with iVKA anticoagulation have an increased risk of complications compared to NOACs. Major complications, such as thromboembolic events, are generally rare and are exceeded by minor bleedings.
authors.affiliation: Department of Cardiology-Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany. m.gunawardene@uke.de.
authors.forename: Melanie
authors.initials: M
authors.lastname: Gunawardene
authors.affiliation: Department of Cardiology-Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Willems
authors.affiliation: Department of Cardiology-Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Schäffer
authors.affiliation: Department of Cardiology-Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Moser
authors.affiliation: Department of Cardiology-Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany.
authors.forename: R Ö
authors.initials: RÖ
authors.lastname: Akbulak
authors.affiliation: Department of Cardiology-Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Jularic
authors.affiliation: Department of Cardiology-Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Eickholt
authors.affiliation: Department of Cardiology-Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Nührich
authors.affiliation: Department of Cardiology-Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Meyer
authors.affiliation: Department of Cardiology-Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Kuklik
authors.affiliation: Institute for Medical Biometry and Epidemiology, University Hospital Hamburg Eppendorf, Hamburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Sehner
authors.affiliation: Department of Cardiology-Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Czerner
authors.affiliation: Department of Cardiology-Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany.
authors.forename: B A
authors.initials: BA
authors.lastname: Hoffmann
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019990:Perioperative Care; D019106:Postoperative Hemorrhage / Q000097:blood / Q000139:chemically induced*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013923:Thromboembolism / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D014812:Vitamin K
keywords: Atrial fibrillation ablation; Catheter ablation; Complication; Non-vitamin K antagonists; Oral anticoagulation; Periprocedural oral anticoagulation; Persistent atrial fibrillation; Vitamin K antagonists