Abstract
Introduction
A recent single-center report indicated that the performance of atrial fibrillation ablation in patients on uninterrupted warfarin using a conventional deflectable tip electrode ablation catheter may be as safe as peri-procedural discontinuation of warfarin and bridging with heparin. Novel multi-electrode array catheters for atrial fibrillation ablation are currently undergoing clinical evaluation. While offering the possibility of more rapid atrial fibrillation ablation, they are stiffer and necessitate the deployment of larger deflectable transseptal sheaths, and it remains to be determined if they increase the risk of cardiac perforation and vascular injury. Such potential risks would have implications for a strategy of uninterrupted peri-procedural anticoagulation.
Method and Results
We audited the safety outcomes of our atrial fibrillation ablation procedures using multi-electrode array ablation catheters in patients on uninterrupted warfarin (CHADS2 score ≥ 2) and in patients not on warfarin (uninterrupted aspirin). Two bleeding complications occurred in 49 patients on uninterrupted warfarin, both of which were managed successfully without long-term sequelae, and no bleeding complication occurred in 32 patients not on warfarin (uninterrupted aspirin). There were no thromboembolic events or other complication with either anticoagulant regimen.
Conclusion
Despite the larger diameter and increased stiffness of multi-electrode array catheters and their deflectable transseptal sheaths, their use for catheter ablation in patients with atrial fibrillation on uninterrupted warfarin in this single-center experience does not appear to be unsafe, and thus, an adequately powered multicenter prospective randomized controlled trial should be considered.
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Acknowledgments
We are grateful for the statistical assistance of Mr. Mark Ledwidge.
Disclosures
David Keane is a consultant with Bard, MA and Sanofi Aventis and has a patent licensing agreement with Ablation Frontiers, MN.
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Hayes, C.R., Keane, D. Safety of atrial fibrillation ablation with novel multi-electrode array catheters on uninterrupted anticoagulation—a single-center experience. J Interv Card Electrophysiol 27, 117–122 (2010). https://doi.org/10.1007/s10840-009-9457-9
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DOI: https://doi.org/10.1007/s10840-009-9457-9