Safety of atrial fibrillation ablation with novel multi-electrode array catheters on uninterrupted anticoagulation-a single-center experience.

Hdl Handle:
http://hdl.handle.net/10147/207676
Title:
Safety of atrial fibrillation ablation with novel multi-electrode array catheters on uninterrupted anticoagulation-a single-center experience.
Authors:
Hayes, Christopher Ruslan; Keane, David
Affiliation:
Cardiac Arrhythmia Service, St Vincent's University Hospital, Elm Park, Dublin,, Ireland. chrisrushayes@doctors.org.uk
Citation:
J Interv Card Electrophysiol. 2010 Mar;27(2):117-22.
Journal:
Journal of interventional cardiac electrophysiology : an international journal of, arrhythmias and pacing
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207676
DOI:
10.1007/s10840-009-9457-9
PubMed ID:
20082132
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 periprocedural 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 periprocedural 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>or=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 longterm 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.
Language:
eng
MeSH:
Aged; Anticoagulants/administration & dosage; Atrial Fibrillation/complications/*surgery; Catheter Ablation/*adverse effects; Female; Humans; Male; Middle Aged; Postoperative Hemorrhage/*etiology/*prevention & control; Premedication/*methods; Treatment Outcome; Warfarin/*administration & dosage
ISSN:
1572-8595 (Electronic); 1383-875X (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorHayes, Christopher Ruslanen_GB
dc.contributor.authorKeane, Daviden_GB
dc.date.accessioned2012-02-01T10:34:40Z-
dc.date.available2012-02-01T10:34:40Z-
dc.date.issued2012-02-01T10:34:40Z-
dc.identifier.citationJ Interv Card Electrophysiol. 2010 Mar;27(2):117-22.en_GB
dc.identifier.issn1572-8595 (Electronic)en_GB
dc.identifier.issn1383-875X (Linking)en_GB
dc.identifier.pmid20082132en_GB
dc.identifier.doi10.1007/s10840-009-9457-9en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207676-
dc.description.abstractINTRODUCTION: 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 periprocedural 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 periprocedural 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>or=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 longterm 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.en_GB
dc.language.isoengen_GB
dc.subject.meshAgeden_GB
dc.subject.meshAnticoagulants/administration & dosageen_GB
dc.subject.meshAtrial Fibrillation/complications/*surgeryen_GB
dc.subject.meshCatheter Ablation/*adverse effectsen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshPostoperative Hemorrhage/*etiology/*prevention & controlen_GB
dc.subject.meshPremedication/*methodsen_GB
dc.subject.meshTreatment Outcomeen_GB
dc.subject.meshWarfarin/*administration & dosageen_GB
dc.titleSafety of atrial fibrillation ablation with novel multi-electrode array catheters on uninterrupted anticoagulation-a single-center experience.en_GB
dc.contributor.departmentCardiac Arrhythmia Service, St Vincent's University Hospital, Elm Park, Dublin,, Ireland. chrisrushayes@doctors.org.uken_GB
dc.identifier.journalJournal of interventional cardiac electrophysiology : an international journal of, arrhythmias and pacingen_GB
dc.description.provinceLeinster-

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