Many patients (pts) undergoing atrial flutter (AFL) or atrioventricular node (AVN) catheter ablation require periprocedural anticoagulation (AC). There is no consensus on the optimal AC strategy. In this study we compared efficacy and safety of different periprocedural AC regimes for right-sided arrhythmia ablation.
Methods: 101 consecutive pts who underwent right-sided AFl (70%) or AVN (30%) ablation between 07/2010 and 10/2013 in our department were included in study (29.8% women, mean age 66.6±12.1 years, mean left ventricular ejection fraction (LVEF) 51.5±18.1%, mean CHADS2 score 2±1.3). There were 5 groups of pts with different periprocedural AC strategies: group 1 (17 pts) - treated only by antiplatelet agents , group 2 (9 pts) - treated by novel oral AC (NOAC), group 3 (17 pts) - treated by uninterrupted warfarin with INR >2.0 on day of index ablation, group 4 (41 pts) - treated by warfarin with interruption and INR less than 2.0 and without conversion to low molecular weight heparin (LMWH) and the group 5 (17 pts) - warfarin treated pts with conversion to LMWH (enoxaparin 1 mg/kg bd).
Results: There were no significant differences in baseline characteristics between the groups, except of lower CHADS2 score (1.3±1.3) in group 1. The mean FU was 17.1±12.0. The composite periprocedural complications' rate was 6.93%. 6 of 7 pts with complications were in group 5 (p<0.0004). There were 2 major, 4 minor bleedings and 1 deep vein thrombosis in group 5 and a case of pulmonary embolism in group 4. Late FU bleeding rate was 3.96% (ns). Late FU embolic events rate was 2.97% (ns). Mortality rate on late FU was 5.94% with 3 cases from group 5 (ns).
Conclusions: Periprocedural anticoagulation for right-sided catheter ablation with uninterrupted warfarin or NOAC is superior to warfarin interruption with bridging to LMWH.
