Catheter Ablation of Atrial Fibrillation in Patients at Low Thrombo‐Embolic Risk: Efficacy and Safety of a Simplified Periprocedural Anticoagulation Strategy. (18th April 2013)

• Record Type: Journal Article
• Authors: DUYTSCHAEVER, MATTIAS; BERTE, BENJAMIN; ACENA, MARTA; DE, GRIM; BUN, SOK‐SITHIKUN; VAN, FREDERIC; VANDEKERCKHOVE, YVES; TAVERNIER, RENE
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 24:Number 8(2013:Aug.)
• Page Start: 855
• Page End: 860
• Publication Date: 2013-04-18
• Subjects: Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.12148
• Languages: English
• ISSNs: 1045-3873

Abstract

<abstract abstract-type="main"> <title>Aspirin and Low Molecular Weight Heparin in Patients Undergoing Catheter Ablation of AF</title> <sec id="jce12148-sec-0010" sec-type="section"> <title>Background</title> <p>To prevent thrombo‐embolic (TE) events during ablation of atrial fibrillation (AF), warfarin is recommended in all patients irrespective of baseline TE risk. We evaluated the efficacy and safety of a simplified periprocedural anticoagulation strategy of aspirin (ASA) and low molecular weight heparin (LMWH) in patients at low TE risk.</p> </sec> <sec id="jce12148-sec-0020" sec-type="section"> <title>Methods</title> <p>We collected data from 214 low TE risk patients (CHADS<sub>2</sub> score ≤1 and no warfarin at baseline) undergoing pulmonary vein isolation. After discontinuation of ASA, periprocedural antithrombotic therapy consisted of therapeutic subcutaneous LMWH injections (nadroparin 1 mL/kg once daily) from 10 days before until 10 days after the procedure, followed by ASA in all patients. At the time of procedure, transesophageal echocardiography (TEE) was not performed on a routine basis. During the procedure, unfractionated heparin was administered to achieve an ACT between 350 and 400 seconds. Data on TE events (stroke or transient ischemic attack), cardiac tamponade/perforation, and major vascular access complications within 3 months after the procedure were collected.</p> </sec> <sec id="jce12148-sec-0030" sec-type="section"> <title>Results</title> <p>Mean CHADS<sub>2</sub> was 0.3 ± 0.5. TEE was performed in 3% of patients. No periprocedural TE events occurred. No cardiac tamponade/perforation was observed. Major vascular access complications occurred in 3 patients (1.4%). No permanent injury was observed (0%).</p> </sec> <sec id="jce12148-sec-0040" sec-type="section"> <title>Conclusion</title> <p>In selected low TE risk patients undergoing ablation for AF, a short period of periprocedural therapeutic anticoagulation with LMWH together with aspirin is an effective and safe strategy to prevent TE events. If confirmed in a randomized trial, this approach might simplify periprocedural antithrombotic management in ablation of selected AF patients.</p> </sec> </abstract>