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Immediate post-procedure bridging with unfractioned heparin versus low molecular weight heparin in patients undergoing radiofrequency ablation for atrial fibrillation with an interrupted oral anticoagulation strategy

Journal of Interventional Cardiac Electrophysiology volume 45, pages 149–158 (2016)Cite this article

Abstract

Purpose

Many centers perform catheter ablation for atrial fibrillation (AF) with periprocedural interruption of oral vitamin K antagonists. In this scenario, the optimal post-procedural anticoagulation strategy is still under debate. We sought to compare the incidence of major complications associated with post-procedural use of low molecular weight heparin (LMWH) versus unfractioned heparin (UFH) as a bridge to reinitiation of oral anticoagulation after an AF ablation procedure.

Methods

We retrospectively reviewed medical history data of all patients undergoing catheter ablation for AF at three Spanish referral centers between January 2009 and January 2014. A total of 702 patients were included in the analysis. We compared the incidence of major complications (a combination of major bleeding and thromboembolic events) between patients receiving UFH (291) and those receiving LMWH (411) after the procedure.

Results

The overall incidence of major complications was 4.1 %, including five thromboembolic events (0.7 %) and 24 major bleeding events (3.4 %), with no significant differences in patients treated with LMWH vs. UFH (2.9 vs. 4.1 %; P = NS). The presence of peripheral vascular disease emerged as the only independent predictor of major complications (adjusted odds ratio (OR) 9.1; confidence interval (CI) 95 % 1.7–49.3; P < 0.01).

Conclusions

Immediate post-procedural bridging with UFH or with LMWH are equally safe strategies in patients undergoing catheter ablation for AF in whom oral anticoagulation is interrupted for the procedure. Due to its greater simplicity of use, LMWH may be the preferred option. The presence of peripheral vascular disease is a potent predictor of major post-procedural complications.

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Fig. 1
Fig. 2

Abbreviations

RFA:

Radiofrequency ablation

AF:

Atrial fibrillation

TE:

Thromboembolic events

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Affiliations

  1. Department of Cardiology, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Hospital General Universitario Gregorio Marañón, C/Dr. Esquerdo 46, 28007, Madrid, Spain

    Gerard Loughlin, Tomás Datino Romaniega, Andres Alonso, Xin Li, Angel Arenal, Esteban González-Torrecilla, Felipe Atienza & Francisco Fernández-Avilés

  2. Hospital Universitario Asistencial, Burgos, Spain

    Javier Garcia-Fernandez & Ricardo Salgado

  3. Hospital Universitario Central de Asturias, Oviedo, Spain

    David Calvo

Authors
  1. Gerard Loughlin
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  2. Tomás Datino Romaniega
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  3. Javier Garcia-Fernandez
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  4. David Calvo
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  5. Ricardo Salgado
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  6. Andres Alonso
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  7. Xin Li
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  8. Angel Arenal
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  11. Francisco Fernández-Avilés
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Correspondence to Tomás Datino Romaniega.

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Loughlin, G., Romaniega, T.D., Garcia-Fernandez, J. et al. Immediate post-procedure bridging with unfractioned heparin versus low molecular weight heparin in patients undergoing radiofrequency ablation for atrial fibrillation with an interrupted oral anticoagulation strategy. J Interv Card Electrophysiol 45, 149–158 (2016). https://doi.org/10.1007/s10840-015-0098-x

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  • DOI: https://doi.org/10.1007/s10840-015-0098-x

Keywords

  • Atrial fibrillation
  • Radiofrequency ablation
  • Anticoagulation
  • Heparin
  • Protamine