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Feasibility and safety of percutaneous epicardial access for mapping and ablation for ventricular arrhythmias in patients on oral anticoagulants

  • Koji Miyamoto
  • Ammar M. Killu
  • Danesh K. Kella
  • David O. Hodge
  • Suraj Kapa
  • Siva K. Mulpuru
  • Abhishek J. Deshmukh
  • Douglas L. Packer
  • Samuel J. Asirvatham
  • Thomas M. Munger
  • Paul A. FriedmanEmail author
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Abstract

Purpose

This study aimed to assess the risk of procedure-related complications of percutaneous epicardial access (EpiAcc) for radiofrequency catheter ablation (RFA) of ventricular arrhythmias (VAs) in patients chronically treated oral anticoagulants (OACs) with warfarin compared to those not on OACs.

Methods

We analyzed 205 patients (53 ± 16 years, 155 males) undergoing percutaneous EpiAcc as part of an RFA for VAs, and compared the outcome between patients chronically on OACs with warfarin (OAC group) and those without (non-OAC group).

Results

Forty-seven patients (23%) were chronically treated on OACs before their procedure. EpiAcc in patients on OAC (OAC group) was not associated with an increased risk of cardiac tamponade (11% vs. 6%, p = 0.238) compared to non-OAC group, but a higher risk of need for blood transfusion (17% vs. 6%; p = 0.013). With respect to the OAC group, the international normalized ratio (INR) on the day of the RFA was ≥ 2.0 in 9 patients (19%) and < 2.0 in the remaining 38 patients (81%). The rate of all complication and blood transfusion were similar between them (11% vs. 21%; p = 0.496, 11% vs. 18%; p = 0.600).

Conclusion

Percutaneous EpiAcc in patients on chronic OAC with warfarin did not significantly increase the risk of cardiac tamponade, but was associated with a higher risk of need for blood transfusion. EpiACC in patients with an INR > 2.0 is reasonable in experienced hands when clinical indications are strong.

Keywords

Epicardial access Oral anticoagulants Ventricular arrhythmias Radiofrequency catheter ablation Complications 

Abbreviations

VAs

Ventricular arrhythmias

RFA

Radiofrequency catheter ablation

EpiAcc

Epicardial access

AF

Atrial fibrillation

ICM

Ischemic cardiomyopathy

NICM

Non-ischemic cardiomyopathy

OACs

Oral anticoagulants

LAA

Left atrial appendage

INR

International normalized ratio

FFP

Fresh frozen plasm

ACT

Activated clotting time

LV

Left ventricular

OR

Odds ratio

CI

Confidence interval

HR

Hazard ratio

CHF

Congestive heart failure

AAD

Antiarrhythmic drug

APA

Antiplatelet agents

Notes

Compliance with ethical standards

The study was approved by the institutional review board, and written informed consent was obtained from all patients before the procedure

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10840_2018_441_MOESM1_ESM.docx (28 kb)
ESM 1 (DOCX 28 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Koji Miyamoto
    • 1
  • Ammar M. Killu
    • 1
  • Danesh K. Kella
    • 1
  • David O. Hodge
    • 2
  • Suraj Kapa
    • 1
  • Siva K. Mulpuru
    • 1
  • Abhishek J. Deshmukh
    • 1
  • Douglas L. Packer
    • 1
  • Samuel J. Asirvatham
    • 1
  • Thomas M. Munger
    • 1
  • Paul A. Friedman
    • 1
    Email author
  1. 1.Department of Cardiovascular MedicineMayo ClinicRochesterUSA
  2. 2.Department of Health Sciences ResearchMayo ClinicRochesterUSA

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