Yonsei Med J.  2016 Mar;57(2):342-349. 10.3349/ymj.2016.57.2.342.

Early Experience of Novel Oral Anticoagulants in Catheter Ablation for Atrial Fibrillation: Efficacy and Safety Comparison to Warfarin

• Shin DG
• Kim TH
• Uhm JS
• Kim JY
• Joung B
• Lee MH
• Pak HN

• KMID: 2374038
• DOI: http://doi.org/10.3349/ymj.2016.57.2.342

Abstract

PURPOSE
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.
MATERIALS AND 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.
CONCLUSION
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.

Keyword

Atrial fibrillation; catheter ablation; novel oral anticoagulant; warfarin

MeSH Terms

Aged
Anticoagulants/*therapeutic use
Atrial Fibrillation/complications/*drug therapy/*surgery
Catheter Ablation/*methods
Female
Follow-Up Studies
Hemorrhage/epidemiology
Heparin
Humans
Incidence
Male
Middle Aged
Postoperative Complications/epidemiology
Stroke/epidemiology
Thromboembolism/epidemiology
Treatment Outcome
Warfarin/administration & dosage/*therapeutic use
Anticoagulants
Heparin
Warfarin

Figure

• 

  Fig. 1 Comparison of mean ACT (A) and total heparin dosage (B) between patients in the NOAC and warfarin groups during the procedure. ACT, activated clotting time; NOAC, novel oral anticoagulant.

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  Fig. 2 Diffusion-weighted magnetic resonance imaging of two patients after atrial fibrillation catheter ablation displaying smaller foci of restricted diffusion in (A) the right frontal lobe (arrow) and (B) the left dorsal pons (arrow).

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