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Ultrasound-Guided Access Reduces Vascular Complications in Patients Undergoing Catheter Ablation for Cardiac Arrhythmias. J Clin Med 2022; 11:jcm11226766. [PMID: 36431243 PMCID: PMC9696936 DOI: 10.3390/jcm11226766] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Femoral vascular access using the standard anatomic landmark-guided method is often limited by peripheral artery disease and obesity. We investigated the effect of ultrasound-guided vascular puncture (UGVP) on the rate of vascular complications in patients undergoing catheter ablation for atrial or ventricular arrhythmias. Methods: The data of 479 patients (59% male, mean age 68 years ± 11 years) undergoing catheter ablation for left atrial (n = 426; 89%), right atrial (n = 28; 6%) or ventricular arrhythmias (n = 28; 6%) were analyzed. All patients were on uninterrupted oral anticoagulants and heparin was administered intravenously during the procedure. Femoral access complications were compared between patients undergoing UGVP (n = 320; 67%) and patients undergoing a conventional approach (n = 159; 33%). Complication rates were also compared between patients with a BMI of >30 kg/m2 (n = 136) and patients with a BMI < 30 kg/m2 (n = 343). Results: Total vascular access complications including mild hematomas were n = 37 (7.7%). In the conventional group n = 17 (10.7%) and in the ultrasound (US) group n = 20 (6.3%) total vascular access complications occurred (OR 0.557, 95% CI 0.283−1.096). UGVP significantly reduced the risk of hematoma > 5 cm (OR 0.382, 95% CI 0.148, 0.988) or pseudoaneurysm (OR 0.160, 95% CI 0.032, 0.804). There was no significant difference between the groups regarding retroperitoneal hematomas or AV fistulas (p > 0.05). In patients with BMI > 30 kg/m2, UGVP led to a highly relevant reduction in the risk of total vascular access complications (OR 0.138, 95% CI 0.027, 0.659), hematomas > 5 cm (OR 0.051, 95% CI 0.000, 0.466) and pseudoaneurysms (OR 0.051, 95% CI 0.000, 0.466). Conclusion: UGVP significantly reduces vascular access complications. Patients with a BMI > 30 kg/m2 seem to particularly profit from a UGVP approach.
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Pellegrino PL, Di Monaco A, Santoro F, Grimaldi M, D'Arienzo G, Casavecchia G, Ieva R, Di Biase M, Iacoviello M, Brunetti ND. Near zero vascular complications using echo-guided puncture during catheter ablation of arrhythmias: A retrospective study and literature review. J Arrhythm 2022; 38:395-399. [PMID: 35785379 PMCID: PMC9237317 DOI: 10.1002/joa3.12723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/31/2022] [Accepted: 04/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Catheter ablation (CA) is routinely used for the treatment of arrhythmias. Vascular complications are the most common complications during these procedures. Previous data reported that ultrasound (US)-guided puncture is a useful method to avoid vascular complications. We reported our experience using US-guided puncture in patients undergoing CA for arrhythmias. Methods A total of 273 patients (mean age 57 ± 17 years; 58% male) were referred to our center for CA of arrhythmias from January 2016 to December 2019. All procedures were performed by expert operators, and US-guided vascular access was performed on all patients. Doppler sonography was performed the day after the procedure on all patients. Results Eighty-four patients (31%) underwent atrioventricular nodal reentrant tachycardia ablation, 49 patients (18%) atrioventricular reentrant tachycardia ablation, 14 patients (5%) atrial tachycardia ablation, 25 patients (9%) atrial flutter ablation, 63 patients (23%) atrial fibrillation ablation, and 38 patients (14%) ventricular tachycardia ablation. Vascular pseudo-aneurysms and arteriovenous fistula were defined as major complications; furthermore, venous thrombosis and inguinal hematomas were as defined minor complications. The percentage of major vascular complications was 0.3% (1 arteriovenous fistula) and the percentage of minor vascular complications was 0.3% (1 venous thrombosis). Discussion Ultrasound-guided vascular puncture in patients undergoing CA is useful to improve procedural success and reduce complications.
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Affiliation(s)
| | - Antonio Di Monaco
- Department of CardiologyGeneral Regional Hospital "F. Miulli"BariItaly
- Department of Clinical and Experimental MedicineUniversity of FoggiaFoggiaItaly
| | - Francesco Santoro
- Cardiology UnitPoliclinico Riuniti University HospitalFoggiaItaly
- Department of Medical and Surgical SciencesUniversity of FoggiaFoggiaItaly
| | - Massimo Grimaldi
- Department of CardiologyGeneral Regional Hospital "F. Miulli"BariItaly
| | | | | | - Riccardo Ieva
- Cardiology UnitPoliclinico Riuniti University HospitalFoggiaItaly
| | - Matteo Di Biase
- Department of Medical and Surgical SciencesUniversity of FoggiaFoggiaItaly
| | - Massimo Iacoviello
- Cardiology UnitPoliclinico Riuniti University HospitalFoggiaItaly
- Department of Medical and Surgical SciencesUniversity of FoggiaFoggiaItaly
| | - Natale Daniele Brunetti
- Cardiology UnitPoliclinico Riuniti University HospitalFoggiaItaly
- Department of Medical and Surgical SciencesUniversity of FoggiaFoggiaItaly
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Loginova AI, Kropacheva ES, Maykov EB, Balakhonova TV, Golitsyn SP. [Comparative efficacy and safety of enoxaparin followed by warfarin and rivaroxaban monotherapy in the treatment of venous thrombosis in patients after intracardiac catheter interventions]. TERAPEVT ARKH 2019; 91:32-37. [PMID: 32598812 DOI: 10.26442/00403660.2019.09.000282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
AIM to compare two anticoagulant therapy (ACT) regimens in the treatment of venous thrombosis (VT) in patients after catheter interventions - electrophysiological studies (EFIs) and ablations: enoxaparin followed by warfarin, and rivaroxaban monotherapy. MATERIALS AND METHODS The study included patients from 18 years and older with heart rhythm disorders and planned catheter ablation. When parietal venous thrombosis (VT) were detected at the femoral vein puncture site, all patients were randomly assigned to two treatment groups. In group I enoxaparin 1 mg/kg was prescribed every 12 hours with switching to warfarin after 7 days with maintenance of the target INR values (2.0-3.0). In group II rivaroxaban therapy was started at a dose of 15 mg twise/day for 21 days with a further transition to a dose of 20 mg/day. The total period of observation and treatment of patients was at least 3 months. RESULTS 408 patients were observed, 42 (10.3%) patients with parietal VT were divided into two treatment groups. In group I (n=16) complete lysis of VT was noted by the 7th day of treatment in 7 (58.3%) patients, however this scheme was associated with a greater risk of complications (р=0.003) at the puncture site in the form of arteriovenous fistulae (n=1; 8.3%) and intermuscular hematomas (n=4; 25%). In group II (n=26), no complications were noted, the lysis time of VT was on average 21 days (n=18; 69.2%). Complete lysis of VT was noted in both groups at the time of the control observation point (3rd month). CONCLUSION The efficiency of the two VT treatment regimens was comparable. Enoxaparin therapy is associated with a high risk of local complications, namely intermuscular hematomas (n=4; 25%) and arteriovenous fistulas (n=1; 8.3%). Rivaroxaban monotherapy is safer (p=0.003); in Group II none of the patients had any complications.
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Affiliation(s)
| | | | - E B Maykov
- National Medical Research Center of Cardiology
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Sasaki T, Nakamura K, Minami K, Take Y, Koyama K, Yamashita E, Naito S. Prevalence and Characteristics of Venous Thrombosis after Catheter Ablation of Atrial Fibrillation in Patients Receiving Periprocedural Direct Oral Anticoagulants. J Atr Fibrillation 2019; 11:2090. [PMID: 31139285 DOI: 10.4022/jafib.2090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/19/2017] [Accepted: 09/05/2018] [Indexed: 11/10/2022]
Abstract
Background Periprocedural venous thromboembolisms (VTEs) area rare occurrence but a critical complication after catheter ablation of atrial fibrillation (AF).The aim of this study was to investigate the incidence of symptomatic deep vein thromboses (DVTs) and pulmonary thromboembolisms (PTEs) in patients who underwent AF catheter ablation and received periprocedural oral anticoagulation with direct oral anticoagulants (DOACs). Methods and Results A total of 2,193 consecutive patients undergoing AF catheter ablation with periprocedural DOACs were retrospectively analyzed.Two patients (0.091%) experienced symptomatic DVTs after the ablation, and no patients had any PTEs. One patient was a 72-year-old female who underwent cryoballoon ablation with periprocedural apixaban at a dose of 2.5 mg twice daily. The other patient was a 74-year-old male who underwent a Hot Balloon ablation and thereafter radiofrequency catheter ablation for recurrent AF with edoxaban at30 mg once daily. Both DVT patients underwent AF ablation by the right femoral vein approach, and after discharge had right leg pain and swelling on post-procedural days 4 and 8, respectively. TheDVT was treated by increasing the dose of apixaban and changing it from 30 mg/day of edoxaban to 15-30 mg/day of rivaroxaban, and the thrombi completely disappeared in both patients without any thromboembolic and hemorrhagic complications. Conclusions AF catheter ablation with periprocedural DOAC treatment revealed anextremely low incidence of symptomatic VTEs, which may be successfully treated by increasing the DOAC dose or changing the DOAC type.
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Affiliation(s)
- Takehito Sasaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma 371-0004, Japan
| | - Kohki Nakamura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma 371-0004, Japan
| | - Kentaro Minami
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma 371-0004, Japan
| | - Yutaka Take
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma 371-0004, Japan
| | - Keiko Koyama
- Division of Radiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma 371-0004, Japan
| | - Eiji Yamashita
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma 371-0004, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma 371-0004, Japan
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Groin Haemostasis With a Purse String Suture for Patients Following Catheter Ablation Procedures (GITAR Study). Heart Lung Circ 2019; 28:777-783. [DOI: 10.1016/j.hlc.2018.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/24/2018] [Accepted: 03/08/2018] [Indexed: 11/23/2022]
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Van Kolen K, Ströker E, De Greef Y. Unusual timing of a common complication after pulmonary vein isolation. Neth Heart J 2017; 25:645-646. [PMID: 28766268 PMCID: PMC5653535 DOI: 10.1007/s12471-017-1027-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/24/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- K Van Kolen
- Department of Cardiology - Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium
| | - E Ströker
- Department of Cardiology - Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium.
| | - Y De Greef
- Department of Cardiology - Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium
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Burstein B, Barbosa RS, Kalfon E, Joza J, Bernier M, Essebag V. Venous Thrombosis After Electrophysiology Procedures: A Systematic Review. Chest 2017. [PMID: 28642107 DOI: 10.1016/j.chest.2017.05.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Femoral venous access for catheter introduction represents the cornerstone of electrophysiology (EP) procedures. Limited data are available regarding postprocedure VTE. The aim of this systematic review is to determine the incidence of DVT and pulmonary embolism (PE) associated with femoral vein catheterization during EP procedures. METHODS An electronic search was conducted for studies documenting the incidence of DVT and PE after EP procedures. Studies were classified as atrial fibrillation (AF) or non-AF ablation procedures. RESULTS Two thousand eight-hundred sixty-four studies were evaluated, 16 of which were included in the analysis. The incidence of DVT after AF and non-AF ablations reached as high as 0.33% and 2.38%, respectively, with a pooled incidence of 0% (95% CI, 0%-0.0003%) and 0.24% (95% CI, 0.08%-0.39%), respectively. The incidence of PE was 0.29% after AF ablation and ranged from 0% to 1.67% for non-AF procedures; the pooled incidence after non-AF ablations was 0.12% (95% CI, 0%-0.25%). Asymptomatic DVT was documented in up to 21.2% of patients. Hematomas occurred in 1.05% of AF ablations (95% CI, 0.30%-1.8%) and 0.3% of non-AF ablations (95% CI, 0.09%-0.51%). CONCLUSIONS A lower incidence of symptomatic DVT and PE was observed after AF ablations as opposed to non-AF ablations, likely due to the use of routine periprocedural anticoagulation. Asymptomatic DVTs appear to be common, although their significance is unclear. Future studies are required to weigh the risk of hematoma against the risk of VTE associated with the use of prophylactic anticoagulation after non-AF ablation procedures.
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Affiliation(s)
- Barry Burstein
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Rodrigo S Barbosa
- McGill University Health Centre, Montreal, Quebec, Canada; Hospital Albert Sabin, Juiz de Fora, MG, Brazil
| | - Eli Kalfon
- Galilee Medical Center, Nahariya, Israel
| | | | - Martin Bernier
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Vidal Essebag
- McGill University Health Centre, Montreal, Quebec, Canada; Hôpital Sacré-Coeur de Montréal, Montreal, Quebec, Canada.
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Madrid Pérez JM, García Barquín PM, Villanueva Marcos AJ, García Bolao JI, Bastarrika Alemañ G. Complications associated with radiofrequency ablation of pulmonary veins. RADIOLOGIA 2016; 58:444-453. [PMID: 27769571 DOI: 10.1016/j.rx.2016.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 08/31/2016] [Accepted: 09/12/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Radiofrequency ablation is an efficacious alternative in patients with symptomatic atrial fibrillation who do not respond to or are intolerant to at least one class I or class III antiarrhythmic drug. Although radiofrequency ablation is a safe procedure, complications can occur. Depending on the location, these complications can be classified into those that affect the pulmonary veins themselves, cardiac complications, extracardiac intrathoracic complications, remote complications, and those that result from vascular access. The most common complications are hematomas, arteriovenous fistulas, and pseudoaneurysms at the puncture site. Some complications are benign and transient, such as gastroparesis or diaphragmatic elevation, whereas others are potentially fatal, such as cardiac tamponade. CONCLUSION Radiologists must be familiar with the complications that can occur secondary to pulmonary vein ablation to ensure early diagnosis and treatment.
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Affiliation(s)
- J M Madrid Pérez
- Servicio de Radiodiagnóstico, Clínica Universidad de Navarra, Pamplona, España.
| | - P M García Barquín
- Servicio de Radiodiagnóstico, Clínica Universidad de Navarra, Pamplona, España
| | - A J Villanueva Marcos
- Department of Radiology, Hinchingbrooke Health Care, Huntingdon, Cambridgeshire, Gran Bretaña
| | - J I García Bolao
- Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, España
| | - G Bastarrika Alemañ
- Servicio de Radiodiagnóstico, Clínica Universidad de Navarra, Pamplona, España
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Philip Saul J, Kanter RJ, Abrams D, Asirvatham S, Bar-Cohen Y, Blaufox AD, Cannon B, Clark J, Dick M, Freter A, Kertesz NJ, Kirsh JA, Kugler J, LaPage M, McGowan FX, Miyake CY, Nathan A, Papagiannis J, Paul T, Pflaumer A, Skanes AC, Stevenson WG, Von Bergen N, Zimmerman F. PACES/HRS expert consensus statement on the use of catheter ablation in children and patients with congenital heart disease. Heart Rhythm 2016; 13:e251-89. [DOI: 10.1016/j.hrthm.2016.02.009] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Indexed: 11/15/2022]
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Dalsgaard AB, Jakobsen CS, Riahi S, Hjortshøj S. Groin hematoma after electrophysiological procedures—incidence and predisposing factors. SCAND CARDIOVASC J 2014; 48:311-6. [DOI: 10.3109/14017431.2014.952243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Anja Borgen Dalsgaard
- Department of Cardiology, Cardiovascular Research Centre, Aalborg University Hospital,
Aalborg, Denmark
| | - Christina Spåbæk Jakobsen
- Department of Cardiology, Cardiovascular Research Centre, Aalborg University Hospital,
Aalborg, Denmark
| | - Sam Riahi
- Department of Cardiology, Cardiovascular Research Centre, Aalborg University Hospital,
Aalborg, Denmark
| | - Søren Hjortshøj
- Department of Cardiology, Cardiovascular Research Centre, Aalborg University Hospital,
Aalborg, Denmark
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ERRAHMOUNI ABDELKARIM, BUN SOKSITHIKUN, LATCU DECEBALGABRIEL, SAOUDI NADIR. Ultrasound-Guided Venous Puncture in Electrophysiological Procedures: A Safe Method, Rapidly Learned. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:1023-8. [DOI: 10.1111/pace.12386] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 01/29/2014] [Accepted: 02/14/2014] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - NADIR SAOUDI
- Department of Cardiology; Princess Grace Hospital; Monaco
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Shroff G, Guirguis M, Ferguson E, Oldham S, Kantharia B. CT imaging of complications of catheter ablation for atrial fibrillation. Clin Radiol 2014; 69:96-102. [DOI: 10.1016/j.crad.2013.08.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 08/24/2013] [Accepted: 08/29/2013] [Indexed: 11/29/2022]
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Yamaji H, Murakami T, Hina K, Higashiya S, Kawamura H, Murakami M, Kamikawa S, Hirohata S, Kusachi S. Usefulness of dabigatran etexilate as periprocedural anticoagulation therapy for atrial fibrillation ablation. Clin Drug Investig 2013; 33:409-18. [PMID: 23572324 DOI: 10.1007/s40261-013-0081-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The usefulness of dabigatran etexilate for the prevention of stroke in patients with atrial fibrillation (AF) has been reported. OBJECTIVES In this study the efficacy and safety of dabigatran etexilate for anticoagulation for AF ablation were examined. METHOD Patients were divided into three groups: Group 1, interrupted warfarin bridged by heparin between pre- and post-ablation; Group 2, continuous warfarin therapy; and Group 3, dabigatran etexilate therapy. Anticoagulation therapy with warfarin or dabigatran etexilate was performed from 30 days before to at least 90 days after AF ablation. Dabigatran etexilate was administered at 110 or 150 mg twice daily, depending on renal function and age. RESULTS Patients' clinical characteristics, associated disorders, echocardiographic parameters and arrhythmia status were not different among the three groups. Procedural parameters such as procedural time and radiofrequency energy supply were also not different among the three groups. The dabigatran etexilate group and the warfarin groups had no embolic complications (stroke, cerebral transient ischaemic attack, deep venous thrombosis or pulmonary embolism). No pericardial tamponade was observed in the dabigatran etexilate group, while two patients in each of Group 1 (2/194, 1.0 %) and Group 2 (2/203, 0.98 %) developed cardiac tamponade, though the differences were not significant. Pericardial effusion and groin haematoma were observed in one patient each (1/105, 0.9 %) in the dabigatran etexilate group, and the incidences were not different from the warfarin group (Group 1: 4/194, 2.1 % and 2/194, 1.0 %; Group 2: 3/203, 1.5 % and 2/203, 1.0 %, respectively). As a whole, the safety outcomes did not differ among the three groups. CONCLUSION Dabigatran etexilate is an effective and safe anticoagulation therapy for AF ablation. Thus, dabigatran etexilate appears to be useful as an alternative anticoagulant therapy to warfarin for AF ablation.
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Imamura K, Yoshida A, Takei A, Fukuzawa K, Kiuchi K, Takami K, Takami M, Itoh M, Fujiwara R, Suzuki A, Nakanishi T, Yamashita S, Matsumoto A, Hirata KI. Dabigatran in the peri-procedural period for radiofrequency ablation of atrial fibrillation: efficacy, safety, and impact on duration of hospital stay. J Interv Card Electrophysiol 2013; 37:223-31. [PMID: 23585240 PMCID: PMC3738875 DOI: 10.1007/s10840-013-9801-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 03/05/2013] [Indexed: 11/25/2022]
Abstract
Purpose Dabigatran is effective for both the prevention of stroke and bleeding in patients with atrial fibrillation (AF). However, the safety and efficacy of the use of dabigatran in the peri-procedural period for radiofrequency catheter ablation (RFCA) of AF is unknown. Therefore, the purpose of this study was to evaluate the safety and efficacy of dabigatran in the peri-procedural period for RFCA of AF and the duration of hospital stay. Methods Consecutive patients (n = 227) who underwent RFCA for AF were prospectively analyzed. Peri-procedural anticoagulant therapy with dabigatran (n = 101, D group) was compared with warfarin and heparin bridging (n = 126, W group). Dabigatran was discontinued 12–24 h before and restarted 3 h after the procedure. Warfarin was stopped 3 days before the procedure and unfractionated heparin was administered. Results Ischemic stroke occurred in one patient of the D group (0.8 %). There was no significant difference between the two groups in the incidence of major bleeding (three cases of cardiac tamponade in each group and one case of intracranial bleeding in the W group, p = 0.93) or minor bleeding (five cases in the D group vs. five in the W group, p = 0.54). The duration of hospital stay was significantly shorter in the D group than in the W group (7.2 vs. 10.3 days, p = 0.0001). Conclusions Peri-procedural anticoagulation therapy with dabigatran for RFCA of AF was equally safe and effective compared with warfarin and heparin bridging. The use of dabigatran for RFCA of AF shortened the duration of hospital stay.
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Affiliation(s)
- Kimitake Imamura
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
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Real-time ultrasound guidance reduces total and major vascular complications in patients undergoing pulmonary vein antral isolation on therapeutic warfarin. J Interv Card Electrophysiol 2013; 37:163-8. [PMID: 23585239 DOI: 10.1007/s10840-013-9796-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 02/25/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Vascular complications are a known risk of catheter-based pulmonary vein antral isolation (PVAI). Procedure-related thromboembolic events necessitate full-dose anticoagulation, which worsens outcomes in the event of vascular access injury. OBJECTIVE Real-time ultrasound allows direct visualization of vascular structures. We hypothesized that ultrasound use with venipuncture reduces vascular complications associated with PVAI. METHODS Retrospective analysis of all adverse events occurring with PVAI was performed during two periods: 2005-2006 when ultrasound was not used and 2008-2010 when ultrasound was routinely employed. All patients received full-dose IV heparin during PVAI. In the no ultrasound cohort, only 14 % underwent PVAI without stopping warfarin, while 91 % of patients in the ultrasound cohort were on continued warfarin. Only patients deemed at high risk for thromboembolism with a periprocedural international normalized ratio (INR) less than 2 were bridged with subcutaneous low-molecular-weight heparin. RESULTS Ultrasound reduced total vascular complications (1.7 vs. 0.5 %, p < 0.01) and decreased the incidence of major vascular complications by sevenfold. Warfarin with INR ≥ 1.2 on the day of PVAI was associated with more vascular complications (4.3 vs. 1.2 %, p < 0.01). Ultrasound guidance overcame the risk associated with warfarin therapy. Vascular complications in anticoagulated patients with INR ≥ 1.2 using ultrasound guidance were two- and ninefold lower than those in patients not using ultrasound with an INR < 1.2 (0.5 vs. 1.2 %, p < 0.05) and INR ≥ 1.2 (0.5 vs. 4.3 %, p < 0.01), respectively. CONCLUSION Ultrasound-guided venipuncture improves the safety profile of PVAI, reducing vascular complications in patients on warfarin to levels below those with no ultrasound and off warfarin.
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Bhave PD, Knight BP. Optimal Strategies Including Use of Newer Anticoagulants for Prevention of Stroke and Bleeding Complications Before, During, and After Catheter Ablation of Atrial Fibrillation and Atrial Flutter. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2013; 15:450-66. [PMID: 23568665 DOI: 10.1007/s11936-013-0242-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Prashant D Bhave
- Cardiology Division/Electrophysiology Section, Northwestern University Feinberg School of Medicine, 676 North St. Claire, Suite 600, Chicago, IL, 60611, USA,
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Aldhoon B, Wichterle D, Peichl P, Čihák R, Kautzner J. Complications of catheter ablation for atrial fibrillation in a high-volume centre with the use of intracardiac echocardiography. ACTA ACUST UNITED AC 2012; 15:24-32. [DOI: 10.1093/europace/eus304] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lakkireddy D, Reddy YM, Di Biase L, Vanga SR, Santangeli P, Swarup V, Pimentel R, Mansour MC, D'Avila A, Sanchez JE, Burkhardt JD, Chalhoub F, Mohanty P, Coffey J, Shaik N, Monir G, Reddy VY, Ruskin J, Natale A. Feasibility and Safety of Dabigatran Versus Warfarin for Periprocedural Anticoagulation in Patients Undergoing Radiofrequency Ablation for Atrial Fibrillation. J Am Coll Cardiol 2012; 59:1168-74. [PMID: 22305113 DOI: 10.1016/j.jacc.2011.12.014] [Citation(s) in RCA: 228] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 11/29/2011] [Accepted: 12/15/2011] [Indexed: 11/20/2022]
Affiliation(s)
- Dhanunjaya Lakkireddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital and Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160-7200, USA.
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Abstract
Atrial fibrillation (AF) is the most common arrhythmia requiring treatment that is encountered in clinical practice. Recent advances in the understanding of underlying mechanisms of AF have led to the increased use of catheter ablation (CA) as a treatment modality for paroxysmal, persistent, or long-standing persistent AF in patients with symptomatic AF despite treatment with antiarrhythmic medications. Because of the complexity in technique and anatomic location of the ablation sites, it is not surprising that CA of AF is associated with a greater risk of procedural complications compared with simpler cardiac ablation procedures. Major and minor complications, including life-threatening complications, have been described and quantified. This systematic review describes the potential risks of CA that have been reported over a period and provides insights into the evolving strategies to minimize these complications, thus making CA techniques safer and potentially more efficacious for AF.
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Verma A, Tsang B. The use of anticoagulation during the periprocedure period of atrial fibrillation ablation. Curr Opin Cardiol 2012; 27:55-61. [DOI: 10.1097/hco.0b013e32834dc34d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abhishek F, Heist EK, Barrett C, Danik S, Blendea D, Correnti C, Khan Z, Ruskin JN, Mansour M. Effectiveness of a strategy to reduce major vascular complications from catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 2011; 30:211-5. [DOI: 10.1007/s10840-010-9539-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 12/21/2010] [Indexed: 11/29/2022]
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Page SP, Siddiqui MS, Finlay M, Hunter RJ, Abrams DJ, Dhinoja M, Earley MJ, Sporton SC, Schilling RJ. Catheter Ablation for Atrial Fibrillation on Uninterrupted Warfarin: Can It Be Done Without Echo Guidance? J Cardiovasc Electrophysiol 2010; 22:265-70. [PMID: 21040095 DOI: 10.1111/j.1540-8167.2010.01910.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Stephen P Page
- Department of Electrophysiology, St. Bartholomew's Hospital, West Smithfield, London, UK
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Vazquez SR, Johnson SA, Rondina MT. Peri-procedural anticoagulation in patients undergoing ablation for atrial fibrillation. Thromb Res 2010; 126:e69-77. [PMID: 20053426 DOI: 10.1016/j.thromres.2009.11.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Revised: 11/20/2009] [Accepted: 11/24/2009] [Indexed: 11/16/2022]
Abstract
Radiofrequency catheter ablation is being used with increasing frequency as a strategy to manage atrial fibrillation. Patients undergoing this procedure are at increased short-term risk of thromboembolism for several days and up to 4 weeks or longer after their ablation, and anticoagulation management surrounding the ablation procedure remains controversial. Although no conclusive recommendations can be made, published guidelines and data support therapeutic anticoagulation with warfarin for 3 weeks prior and intravenous heparin during the ablation. Warfarin may either be continued through the ablation or stopped 2-5 days prior. If the latter approach is chosen, a pre-ablation bridging strategy of enoxaparin 1mg/kg twice daily is reasonable in selected patients unless the patient's bleeding risk dictates using a lower dose regimen (0.5mg/kg twice daily) or avoiding bridging altogether. Fewer data are available for post-ablation management strategies, and current practice patterns are based largely on single-center experiences in smaller, non-randomized studies. For lower risk patients (CHADS(2) 0-1), either warfarin or aspirin may be utilized without bridging. In higher thromboembolic risk patients (CHADS(2) >or=2), either enoxaparin (1mg/kg twice daily) or heparin may be started within the first 12-24h post-procedure. For patients with bleeding risk factors, enoxaparin may be subsequently reduced to 0.5mg/kg until the INR is therapeutic, although the efficacy of this lower dosing regimen has not been well studied. In accordance with national guidelines, warfarin should be continued post-ablation for a minimum of 2 months and then indefinitely in patients with a CHADS(2) score >or= 2.
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Affiliation(s)
- Sara R Vazquez
- University of Utah Thrombosis Service, University of Utah, Department of Pharmacy Services, 675 Arapeen Drive, Suite 100, Salt Lake City, UT 84108, USA.
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