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



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.


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).


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).


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.


Epicardial access Oral anticoagulants Ventricular arrhythmias Radiofrequency catheter ablation Complications 



Ventricular arrhythmias


Radiofrequency catheter ablation


Epicardial access


Atrial fibrillation


Ischemic cardiomyopathy


Non-ischemic cardiomyopathy


Oral anticoagulants


Left atrial appendage


International normalized ratio


Fresh frozen plasm


Activated clotting time


Left ventricular


Odds ratio


Confidence interval


Hazard ratio


Congestive heart failure


Antiarrhythmic drug


Antiplatelet agents


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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