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Effect of uninterrupted dabigatran or rivaroxaban on achieving ideal activated clotting time to heparin response during catheter ablation in patients with atrial fibrillation. J Geriatr Cardiol 2022; 19:565-574. [PMID: 36339467 PMCID: PMC9630001 DOI: 10.11909/j.issn.1671-5411.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Uninterrupted use of oral anticoagulants before atrial fibrillation (AF) ablation can reduce the incidence of perioperative thromboembolic events. However, the effect of new oral anticoagulants on activated clotting time (ACT) in response to heparin during AF ablation in Chinese populations remains unknown. The aim of the present retrospective study was to investigate the value of ACTs in response to intraoperative heparin administration in patients using dabigatran or rivaroxaban. METHODS From January 2018 to December 2021, a total of 173 patients undergoing AF ablation were included in the study, in which 101 patients were treated with dabigatran, 72 patients were treated with rivaroxaban. The intraoperative ACT values were examined in both groups. The incidence of periprocedural complications was evaluated. RESULTS Initial heparin dosage (88 ± 19 U/kg vs. 78 ± 27 U/kg, P < 0.05), total heparin dosage (137 ± 41 U/kg vs. 106 ± 52 U/kg, P < 0.05) during the ablation procedure were higher in the dabigatran group than those in the rivaroxaban group. Mean ACT (280 ± 36 s vs. 265 ± 30 s, P < 0.05), and the percentage of ACTs within the therapeutic range (250-350 s) (74% ± 26% vs. 60% ± 29%, P < 0.05) were significantly lower in the dabigatran group than those in the rivaroxaban group, particularly in male patients. Furthermore, the average time of achieving the target ACT (250-350 s) was also found longer in the dabigatran group (P < 0.05) as compared with the rivaroxaban group. No significant difference was found in the incidence of periprocedural complications between the two groups. CONCLUSIONS The anticoagulant effect of uninterrupted rivaroxaban therapy appears to be more stable and efficient than dabigatran administration during catheter ablation in patients with AF.
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Wu Y, Zhu X, Ning Z. Efficacy of statins combined with amiodarone in the treatment of atrial fibrillation: A meta-analysis. EUR J INFLAMM 2022. [DOI: 10.1177/1721727x221094426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: Atrial fibrillation (AF) is a common arrhythmia in clinics with a high mortality rate. Recently, statins combined with amiodarone and amiodarone alone were used in the treatment of AF. This systematic review study aims to investigate the clinical efficacy and usefulness of statins combined with amiodarone and amiodarone alone in treating AF. Methods: Pubmed, Embase, Web of Science, Medline, Cochrane Library, and China National Knowledge Infrastructure were used to search for the relevant studies and full-text articles involved in evaluating statin-amiodarone versus amiodarone alone for AF. All included articles were quality assessed, and the data analysis was conducted with Review Manager 5.4. Results: Eight (8) relevant studies with 758 AF patients were included in this analysis. In the Meta-analysis, Statin-amiodarone treatment reduced AF recurrence (RR, 0.61; 95% CI, 0.50–0.75; p < 0.00001), C-reactive protein (CRP) level (MD, 0.96; 95%CI, 0.64–1.29, p < 0.00001) and Left atrial diameter (LAD) (MD, 0.81; 95%CI, 0.06–1.56; p = 0.03) compared with amiodarone alone for AF. However, no difference was observed for change of total cholesterol (TC) (MD, 1.32; 95%CI, −0.24–2.88; p = 0.10). Conclusion: Statin-amiodarone effectively reduced CRP level, LAD and reduced the recurrence of AF than amiodarone alone.
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Affiliation(s)
- Yingbiao Wu
- Department of Cardiology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Xi Zhu
- Department of Cardiology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Zhongping Ning
- Department of Cardiology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
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Bawazeer GA, Alkofide HA, Alsharafi AA, Babakr NO, Altorkistani AM, Kashour TS, Miligkos M, AlFaleh KM, Al-Ansary LA. Interrupted versus uninterrupted anticoagulation therapy for catheter ablation in adults with arrhythmias. Cochrane Database Syst Rev 2021; 10:CD013504. [PMID: 34674223 PMCID: PMC8530018 DOI: 10.1002/14651858.cd013504.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The management of anticoagulation therapy around the time of catheter ablation (CA) procedure for adults with arrhythmia is critical and yet is variable in clinical practice. The ideal approach for safe and effective perioperative management should balance the risk of bleeding during uninterrupted anticoagulation while minimising the risk of thromboembolic events with interrupted therapy. OBJECTIVES To compare the efficacy and harms of interrupted versus uninterrupted anticoagulation therapy for catheter ablation (CA) in adults with arrhythmias. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and SCI-Expanded on the Web of Science for randomised controlled trials on 5 January 2021. We also searched three registers on 29 May 2021 to identify ongoing or unpublished trials. We performed backward and forward searches on reference lists of included trials and other systematic reviews and contacted experts in the field. We applied no restrictions on language or publication status. SELECTION CRITERIA We included randomised controlled trials comparing uninterrupted anticoagulation with any modality of interruption with or without heparin bridging for CA in adults aged 18 years or older with arrhythmia. DATA COLLECTION AND ANALYSIS Two review authors conducted independent screening, data extraction, and assessment of risk of bias. A third review author resolved disagreements. We extracted data on study population, interruption strategy, ablation procedure, thromboembolic events (stroke or systemic embolism), major and minor bleeding, asymptomatic thromboembolic events, cardiovascular and all-cause mortality, quality of life (QoL), length of hospital stay, cost, and source of funding. We used GRADE to assess the certainty of the evidence. MAIN RESULTS: We identified 12 studies (4714 participants) that compared uninterrupted periprocedural anticoagulation with interrupted anticoagulation. Studies performed an interruption strategy by either a complete interruption (one study) or by a minimal interruption (11 studies), of which a single-dose skipped strategy was used (nine studies) or two-dose skipped strategy (two studies), with or without heparin bridging. Studies included participants with a mean age of 65 years or greater, with only two studies conducted in relatively younger individuals (mean age less than 60 years). Paroxysmal atrial fibrillation (AF) was the primary type of AF in all studies, and seven studies included other types of AF (persistent and long-standing persistent). Most participants had CHADS2 or CHADS2-VASc demonstrating a low-moderate risk of stroke, with almost all participants having normal or mildly reduced renal function. Ablation source using radiofrequency energy was the most common (seven studies). Ten studies (2835 participants) were conducted in East Asian countries (Japan, China, and South Korea), while the remaining two studies were conducted in the USA. Eight studies were conducted in a single centre. Postablation follow-up was variable among studies at less than 30 days (three studies), 30 days (six studies), and more than 30 days postablation (three studies). Overall, the meta-analysis showed high uncertainty of the effect between the interrupted strategy compared to uninterrupted strategy on the primary outcomes of thromboembolic events (risk ratio (RR) 1.76, 95% confidence interval (CI) 0.33 to 9.46; I2 = 59%; 6 studies, 3468 participants; very low-certainty evidence). However, subgroup analysis showed that uninterrupted vitamin A antagonist (VKA) is associated with a lower risk of thromboembolic events without increasing the risk of bleeding. There is also uncertainty on the outcome of major bleeding events (RR 1.10, 95% CI 0.59 to 2.05; I2 = 6%; 10 studies, 4584 participants; low-certainty evidence). The uncertainty was also evident for the secondary outcomes of minor bleeding (RR 1.01, 95% CI 0.46 to 2.22; I2 = 87%; 9 studies, 3843 participants; very low-certainty evidence), all-cause mortality (RR 0.34, 95% CI 0.01 to 8.21; 442 participants; low-certainty evidence) and asymptomatic thromboembolic events (RR 1.45, 95% CI 0.85 to 2.47; I2 = 56%; 6 studies, 1268 participants; very low-certainty evidence). There was a lower risk of the composite endpoint of thromboembolic events (stroke, systemic embolism, major bleeding, and all-cause mortality) in the interrupted compared to uninterrupted arm (RR 0.23, 95% CI 0.07 to 0.81; 1 study, 442 participants; low-certainty evidence). In general, the low event rates, different comparator anticoagulants, and use of different ablation procedures may be the cause of imprecision and heterogeneity observed. AUTHORS' CONCLUSIONS This meta-analysis showed that the evidence is uncertain to inform the decision to either interrupt or continue anticoagulation therapy around CA procedure in adults with arrhythmia on outcomes of thromboembolic events, major and minor bleeding, all-cause mortality, asymptomatic thromboembolic events, and a composite endpoint of thromboembolic events (stroke, systemic embolism, major bleeding, and all-cause mortality). Most studies in the review adopted a minimal interruption strategy which has the advantage of reducing the risk of bleeding while maintaining a lower level of anticoagulation to prevent periprocedural thromboembolism, hence low event rates on the primary outcomes of thromboembolism and bleeding. The one study that adopted a complete interruption of VKA showed that uninterrupted VKA reduces the risk of thromboembolism without increasing the risk of bleeding. Hence, future trials with larger samples, tailored to a more generalisable population and using homogeneous periprocedural anticoagulant therapy and ablation source are required to address the safety and efficacy of the optimal management of anticoagulant therapy prior to ablation.
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Affiliation(s)
- Ghada A Bawazeer
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Hadeel A Alkofide
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Aya A Alsharafi
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Nada O Babakr
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | | | - Tarek S Kashour
- Department of Cardiology, King Saud University, Riyadh, Saudi Arabia
| | - Michael Miligkos
- Department of Biomathematics, Medical School, University of Thessaly, Larissa, Greece
| | - Khalid M AlFaleh
- Department of Pediatrics (Division of Neonatology), King Saud University, Riyadh, Saudi Arabia
| | - Lubna A Al-Ansary
- Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
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Oshima T, Fujiu K, Matsunaga H, Matsuda J, Matsubara T, Saga A, Yoshida Y, Shimizu Y, Hasumi E, Oguri G, Kojima T, Komuro I. Uninterrupted Direct Oral Anticoagulants Without a Change in Regimen for Catheter Ablation for Atrial Fibrillation Is an Acceptable Protocol. Circ Rep 2021; 3:481-487. [PMID: 34568626 PMCID: PMC8423616 DOI: 10.1253/circrep.cr-20-0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 06/13/2021] [Accepted: 06/23/2021] [Indexed: 11/09/2022] Open
Abstract
Background:
In patients undergoing catheter ablation (CA) for atrial fibrillation (AF), the use of uninterrupted direct oral anticoagulants (DOACs) is the current protocol. This study evaluated bleeding complications following the uninterrupted use of 4 DOACs in patients undergoing CA for AF without any change in the dosing regimen. Moreover, we assessed differences between once- and twice-daily DOAC dosing in patients undergoing CA for AF who continued on DOACs without any change in the dosing regimen. Methods and Results:
This study was a retrospective single-center cohort study of consecutive patients. All patients continued DOACs without interruption or changes to the dosing schedule, even in the case of morning procedures. The primary endpoint was the incidence of major bleeding events within the first 30 days after CA. In all, 710 consecutive patients were included in the study. Bleeding complications were less frequent in the uninterrupted twice- than once-daily DOACs group. However, the incidence of cardiac tamponade across all DOACs was low (0.98%; 7/710), suggesting that uninterrupted DOACs without changes to the dosing regimen may be an acceptable strategy. The rate of total bleeding events, including minor bleeding (12/710; 1.6%), was also satisfactory. Conclusions:
Uninterrupted DOACs without any change in dosing regimen for patients undergoing CA for AF is acceptable. Bleeding complications may be less frequent in patients receiving DOACs twice rather than once daily.
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Affiliation(s)
- Tsukasa Oshima
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan.,Department of Advanced Cardiology, School of Medicine, The University of Tokyo Tokyo Japan
| | - Hiroshi Matsunaga
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Jun Matsuda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Takumi Matsubara
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Akiko Saga
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Yuriko Yoshida
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Yu Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Eriko Hasumi
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Gaku Oguri
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Toshiya Kojima
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan
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Schilling R, Bollmann A. Is cryoballoon ablation in community hospitals the future for atrial fibrillation treatment? Europace 2021; 23:1689-1690. [PMID: 34244714 DOI: 10.1093/europace/euab166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Andreas Bollmann
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
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Calkins H, Willems S, Verma A, Schilling R, Hohnloser SH, Okumura K, Nordaby M, Kleine E, Bis B, Gerstenfeld EP. Heparin dosing in uninterrupted anticoagulation with dabigatran vs. warfarin in atrial fibrillation ablation: RE-CIRCUIT study. Europace 2020; 21:879-885. [PMID: 30982849 PMCID: PMC6781146 DOI: 10.1093/europace/euz057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 03/18/2019] [Indexed: 01/10/2023] Open
Abstract
AIMS To describe heparin dosing requirements in patients who underwent catheter ablation of atrial fibrillation with uninterrupted anticoagulation using dabigatran etexilate (dabigatran) or warfarin to attain therapeutic activated clotting time (ACT) in the RE-CIRCUIT® study. The RE-CIRCUIT study showed significantly fewer major bleeding events in the dabigatran vs. warfarin treatment group. Unfractionated heparin was administered during the procedure to maintain ACT >300 s. METHODS AND RESULTS Patients were randomly assigned to dabigatran 150 mg bid or international normalized ratio-adjusted warfarin. Ablation was performed with uninterrupted anticoagulation and continued for 8 weeks after the procedure. Heparin was administered after placement of femoral sheaths before or immediately after transseptal puncture. Ablation was performed in 635 patients (dabigatran, 317; warfarin, 318); data were available from 396 patients administered heparin (dabigatran, 191; warfarin, 205). Most frequent time window from last dose of study drug to septal puncture was 0 to <4 h in the dabigatran (41.3%) and 16 to <24 h in the warfarin arms (44.7%). Overall mean (standard deviation) heparin dose was similar between the dabigatran and warfarin groups [12 402 (10 721) vs. 11 910 (8359) IU, respectively]. Heparin dosing requirement to reach therapeutic ACT was lowest when time from last dose of dabigatran to septal puncture was 0 to <4 h. CONCLUSION Patients treated with dabigatran required a similar amount of unfractionated heparin as those treated with warfarin to achieve an ACT of >300 s during ablation. More heparin units were required when the time from the last dose of dabigatran to septal puncture increased.
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Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | | | - Atul Verma
- University of Toronto, Toronto, Ontario, Canada
| | | | | | - Ken Okumura
- Saiseikai Kumamoto Hospital, Cardiovascular Center, Kumamoto, Japan
| | - Matias Nordaby
- Boehringer Ingelheim Pharma, Ingelheim am Rhein, Germany
| | - Eva Kleine
- Boehringer Ingelheim Pharma, Ingelheim am Rhein, Germany
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7
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Yang P, Wang C, Ye Y, Huang T, Yang S, Shen W, Xu G, Wu Q. Interrupted or Uninterrupted Oral Anticoagulants in Patients Undergoing Atrial Fibrillation Ablation. Cardiovasc Drugs Ther 2020; 34:371-381. [PMID: 32232617 DOI: 10.1007/s10557-020-06967-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE The safety and efficacy of uninterrupted, minimally interrupted (one dose skipped) or completely interrupted (24 h skipped) oral anticoagulant therapy in patients with atrial fibrillation (AF) ablation are poorly defined. We conducted a network meta-analysis to explore the effect of interrupted or uninterrupted oral anticoagulants in patients with AF undergoing ablation. METHODS The Cochrane Library, PubMed and Embase databases were systematically searched for studies comparing uninterrupted, minimally interrupted or completely interrupted non-vitamin K antagonist oral anticoagulants (NOACs) with continuous or interrupted warfarin in patients undergoing AF ablation. RESULTS Twelve randomized clinical trials (RCTs) with a total of 5597 patients with AF undergoing catheter ablation were included. For thromboembolism, minimally interrupted NOACs (OR 0.03, 95% CI 0.01-0.35), uninterrupted NOACs (OR 0.04, 95% CI 0.01-0.23) and continuous VKAs (OR 0.05, 95% CI 0.01-0.21) were better than interrupted warfarin. The risk of total bleeding appeared higher in the completely interrupted NOAC group compared with the minimally interrupted NOACs (OR 2.74, 95% CI 1.18-6.37), uninterrupted NOACs (OR 2.15, 95% CI 1.05-4.38) and uninterrupted warfarin (OR 2.04, 95% CI 1.02-4.08). To reduce the risk of total bleeding, minimally interrupted NOACs (OR 0.15, 95% CI 0.08-0.27), uninterrupted NOACs (OR 0.19, 95% CI 0.14-0.42) and uninterrupted warfarin (OR 0.24, 95% CI 0.15-0.39) were better than interrupted warfarin. In the event of major bleeding, there was no significant difference in the interrupted NOAC, uninterrupted NOAC, interrupted VKA and uninterrupted VKA groups. CONCLUSIONS These three NOAC strategies may have similar safety and efficacy in terms of thromboembolism and major bleeding complications. The total bleeding risk of completely interrupted oral anticoagulants is higher than that of uninterrupted and minimally interrupted NOACs. For thromboembolism, minimally interrupted NOACs, uninterrupted NOACs and continuous VKAs were better than interrupted warfarin.
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Affiliation(s)
- Pingping Yang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Chenxi Wang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Yinquan Ye
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, 330006, Jiangxi, People's Republic of China
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Tieqiu Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Shuai Yang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Wen Shen
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Gaosi Xu
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Qinghua Wu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, 330006, Jiangxi, People's Republic of China.
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8
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Winkle RA. Periprocedural DOAC Anticoagulation Interruption Strategies for Atrial Fibrillation Ablation: Can a Physician Actually Choose the One They Like? JACC Clin Electrophysiol 2018; 4:807-809. [PMID: 29929674 DOI: 10.1016/j.jacep.2018.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 05/17/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Roger A Winkle
- Silicon Valley Cardiology, Palo Alto Medical Foundation, Sutter Health, Palo Alto, California; Sequoia Hospital, Redwood City, California.
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9
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Calkins H, Willems S, Gerstenfeld EP, Verma A, Schilling R, Hohnloser SH, Okumura K, Serota H, Nordaby M, Guiver K, Biss B, Brouwer MA, Grimaldi M. Uninterrupted Dabigatran versus Warfarin for Ablation in Atrial Fibrillation. N Engl J Med 2017; 376:1627-1636. [PMID: 28317415 DOI: 10.1056/nejmoa1701005] [Citation(s) in RCA: 294] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Catheter ablation of atrial fibrillation is typically performed with uninterrupted anticoagulation with warfarin or interrupted non-vitamin K antagonist oral anticoagulant therapy. Uninterrupted anticoagulation with a non-vitamin K antagonist oral anticoagulant, such as dabigatran, may be safer; however, controlled data are lacking. We investigated the safety of uninterrupted dabigatran versus warfarin in patients undergoing ablation of atrial fibrillation. METHODS In this randomized, open-label, multicenter, controlled trial with blinded adjudicated end-point assessments, we randomly assigned patients scheduled for catheter ablation of paroxysmal or persistent atrial fibrillation to receive either dabigatran (150 mg twice daily) or warfarin (target international normalized ratio, 2.0 to 3.0). Ablation was performed after 4 to 8 weeks of uninterrupted anticoagulation, which was continued during and for 8 weeks after ablation. The primary end point was the incidence of major bleeding events during and up to 8 weeks after ablation; secondary end points included thromboembolic and other bleeding events. RESULTS The trial enrolled 704 patients across 104 sites; 635 patients underwent ablation. Baseline characteristics were balanced between treatment groups. The incidence of major bleeding events during and up to 8 weeks after ablation was lower with dabigatran than with warfarin (5 patients [1.6%] vs. 22 patients [6.9%]; absolute risk difference, -5.3 percentage points; 95% confidence interval, -8.4 to -2.2; P<0.001). Dabigatran was associated with fewer periprocedural pericardial tamponades and groin hematomas than warfarin. The two treatment groups had a similar incidence of minor bleeding events. One thromboembolic event occurred in the warfarin group. CONCLUSIONS In patients undergoing ablation for atrial fibrillation, anticoagulation with uninterrupted dabigatran was associated with fewer bleeding complications than uninterrupted warfarin. (Funded by Boehringer Ingelheim; RE-CIRCUIT ClinicalTrials.gov number, NCT02348723 .).
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Affiliation(s)
- Hugh Calkins
- From Johns Hopkins Medical Institutions, Baltimore (H.C.); Department of Cardiology-Electrophysiology, University Heart Center Hamburg, Hamburg (S.W.), Department of Cardiology, J.W. Goethe University, Frankfurt (S.H.H.), and Boehringer Ingelheim Pharma, Ingelheim am Rhein (M.N.) - all in Germany; Section of Cardiac Electrophysiology, University of California, San Francisco, San Francisco (E.P.G.); University of Toronto, Toronto (A.V.); Barts Heart Centre, Saint Bartholomew's Hospital, London (R.S.), and Biometrics and Data Sciences Department, Boehringer Ingelheim, Bracknell (K.G.) - both in the United Kingdom; Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan (K.O.); St. Louis Heart and Vascular, St. Louis (H.S.); Department of Clinical Operations, Boehringer Ingelheim Regional Center Vienna, Vienna (B.B.); Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (M.A.B.); and Cardiology Department, Miulli Hospital, Acquaviva delle Fonti, Italy (M.G.)
| | - Stephan Willems
- From Johns Hopkins Medical Institutions, Baltimore (H.C.); Department of Cardiology-Electrophysiology, University Heart Center Hamburg, Hamburg (S.W.), Department of Cardiology, J.W. Goethe University, Frankfurt (S.H.H.), and Boehringer Ingelheim Pharma, Ingelheim am Rhein (M.N.) - all in Germany; Section of Cardiac Electrophysiology, University of California, San Francisco, San Francisco (E.P.G.); University of Toronto, Toronto (A.V.); Barts Heart Centre, Saint Bartholomew's Hospital, London (R.S.), and Biometrics and Data Sciences Department, Boehringer Ingelheim, Bracknell (K.G.) - both in the United Kingdom; Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan (K.O.); St. Louis Heart and Vascular, St. Louis (H.S.); Department of Clinical Operations, Boehringer Ingelheim Regional Center Vienna, Vienna (B.B.); Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (M.A.B.); and Cardiology Department, Miulli Hospital, Acquaviva delle Fonti, Italy (M.G.)
| | - Edward P Gerstenfeld
- From Johns Hopkins Medical Institutions, Baltimore (H.C.); Department of Cardiology-Electrophysiology, University Heart Center Hamburg, Hamburg (S.W.), Department of Cardiology, J.W. Goethe University, Frankfurt (S.H.H.), and Boehringer Ingelheim Pharma, Ingelheim am Rhein (M.N.) - all in Germany; Section of Cardiac Electrophysiology, University of California, San Francisco, San Francisco (E.P.G.); University of Toronto, Toronto (A.V.); Barts Heart Centre, Saint Bartholomew's Hospital, London (R.S.), and Biometrics and Data Sciences Department, Boehringer Ingelheim, Bracknell (K.G.) - both in the United Kingdom; Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan (K.O.); St. Louis Heart and Vascular, St. Louis (H.S.); Department of Clinical Operations, Boehringer Ingelheim Regional Center Vienna, Vienna (B.B.); Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (M.A.B.); and Cardiology Department, Miulli Hospital, Acquaviva delle Fonti, Italy (M.G.)
| | - Atul Verma
- From Johns Hopkins Medical Institutions, Baltimore (H.C.); Department of Cardiology-Electrophysiology, University Heart Center Hamburg, Hamburg (S.W.), Department of Cardiology, J.W. Goethe University, Frankfurt (S.H.H.), and Boehringer Ingelheim Pharma, Ingelheim am Rhein (M.N.) - all in Germany; Section of Cardiac Electrophysiology, University of California, San Francisco, San Francisco (E.P.G.); University of Toronto, Toronto (A.V.); Barts Heart Centre, Saint Bartholomew's Hospital, London (R.S.), and Biometrics and Data Sciences Department, Boehringer Ingelheim, Bracknell (K.G.) - both in the United Kingdom; Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan (K.O.); St. Louis Heart and Vascular, St. Louis (H.S.); Department of Clinical Operations, Boehringer Ingelheim Regional Center Vienna, Vienna (B.B.); Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (M.A.B.); and Cardiology Department, Miulli Hospital, Acquaviva delle Fonti, Italy (M.G.)
| | - Richard Schilling
- From Johns Hopkins Medical Institutions, Baltimore (H.C.); Department of Cardiology-Electrophysiology, University Heart Center Hamburg, Hamburg (S.W.), Department of Cardiology, J.W. Goethe University, Frankfurt (S.H.H.), and Boehringer Ingelheim Pharma, Ingelheim am Rhein (M.N.) - all in Germany; Section of Cardiac Electrophysiology, University of California, San Francisco, San Francisco (E.P.G.); University of Toronto, Toronto (A.V.); Barts Heart Centre, Saint Bartholomew's Hospital, London (R.S.), and Biometrics and Data Sciences Department, Boehringer Ingelheim, Bracknell (K.G.) - both in the United Kingdom; Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan (K.O.); St. Louis Heart and Vascular, St. Louis (H.S.); Department of Clinical Operations, Boehringer Ingelheim Regional Center Vienna, Vienna (B.B.); Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (M.A.B.); and Cardiology Department, Miulli Hospital, Acquaviva delle Fonti, Italy (M.G.)
| | - Stefan H Hohnloser
- From Johns Hopkins Medical Institutions, Baltimore (H.C.); Department of Cardiology-Electrophysiology, University Heart Center Hamburg, Hamburg (S.W.), Department of Cardiology, J.W. Goethe University, Frankfurt (S.H.H.), and Boehringer Ingelheim Pharma, Ingelheim am Rhein (M.N.) - all in Germany; Section of Cardiac Electrophysiology, University of California, San Francisco, San Francisco (E.P.G.); University of Toronto, Toronto (A.V.); Barts Heart Centre, Saint Bartholomew's Hospital, London (R.S.), and Biometrics and Data Sciences Department, Boehringer Ingelheim, Bracknell (K.G.) - both in the United Kingdom; Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan (K.O.); St. Louis Heart and Vascular, St. Louis (H.S.); Department of Clinical Operations, Boehringer Ingelheim Regional Center Vienna, Vienna (B.B.); Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (M.A.B.); and Cardiology Department, Miulli Hospital, Acquaviva delle Fonti, Italy (M.G.)
| | - Ken Okumura
- From Johns Hopkins Medical Institutions, Baltimore (H.C.); Department of Cardiology-Electrophysiology, University Heart Center Hamburg, Hamburg (S.W.), Department of Cardiology, J.W. Goethe University, Frankfurt (S.H.H.), and Boehringer Ingelheim Pharma, Ingelheim am Rhein (M.N.) - all in Germany; Section of Cardiac Electrophysiology, University of California, San Francisco, San Francisco (E.P.G.); University of Toronto, Toronto (A.V.); Barts Heart Centre, Saint Bartholomew's Hospital, London (R.S.), and Biometrics and Data Sciences Department, Boehringer Ingelheim, Bracknell (K.G.) - both in the United Kingdom; Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan (K.O.); St. Louis Heart and Vascular, St. Louis (H.S.); Department of Clinical Operations, Boehringer Ingelheim Regional Center Vienna, Vienna (B.B.); Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (M.A.B.); and Cardiology Department, Miulli Hospital, Acquaviva delle Fonti, Italy (M.G.)
| | - Harvey Serota
- From Johns Hopkins Medical Institutions, Baltimore (H.C.); Department of Cardiology-Electrophysiology, University Heart Center Hamburg, Hamburg (S.W.), Department of Cardiology, J.W. Goethe University, Frankfurt (S.H.H.), and Boehringer Ingelheim Pharma, Ingelheim am Rhein (M.N.) - all in Germany; Section of Cardiac Electrophysiology, University of California, San Francisco, San Francisco (E.P.G.); University of Toronto, Toronto (A.V.); Barts Heart Centre, Saint Bartholomew's Hospital, London (R.S.), and Biometrics and Data Sciences Department, Boehringer Ingelheim, Bracknell (K.G.) - both in the United Kingdom; Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan (K.O.); St. Louis Heart and Vascular, St. Louis (H.S.); Department of Clinical Operations, Boehringer Ingelheim Regional Center Vienna, Vienna (B.B.); Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (M.A.B.); and Cardiology Department, Miulli Hospital, Acquaviva delle Fonti, Italy (M.G.)
| | - Matias Nordaby
- From Johns Hopkins Medical Institutions, Baltimore (H.C.); Department of Cardiology-Electrophysiology, University Heart Center Hamburg, Hamburg (S.W.), Department of Cardiology, J.W. Goethe University, Frankfurt (S.H.H.), and Boehringer Ingelheim Pharma, Ingelheim am Rhein (M.N.) - all in Germany; Section of Cardiac Electrophysiology, University of California, San Francisco, San Francisco (E.P.G.); University of Toronto, Toronto (A.V.); Barts Heart Centre, Saint Bartholomew's Hospital, London (R.S.), and Biometrics and Data Sciences Department, Boehringer Ingelheim, Bracknell (K.G.) - both in the United Kingdom; Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan (K.O.); St. Louis Heart and Vascular, St. Louis (H.S.); Department of Clinical Operations, Boehringer Ingelheim Regional Center Vienna, Vienna (B.B.); Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (M.A.B.); and Cardiology Department, Miulli Hospital, Acquaviva delle Fonti, Italy (M.G.)
| | - Kelly Guiver
- From Johns Hopkins Medical Institutions, Baltimore (H.C.); Department of Cardiology-Electrophysiology, University Heart Center Hamburg, Hamburg (S.W.), Department of Cardiology, J.W. Goethe University, Frankfurt (S.H.H.), and Boehringer Ingelheim Pharma, Ingelheim am Rhein (M.N.) - all in Germany; Section of Cardiac Electrophysiology, University of California, San Francisco, San Francisco (E.P.G.); University of Toronto, Toronto (A.V.); Barts Heart Centre, Saint Bartholomew's Hospital, London (R.S.), and Biometrics and Data Sciences Department, Boehringer Ingelheim, Bracknell (K.G.) - both in the United Kingdom; Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan (K.O.); St. Louis Heart and Vascular, St. Louis (H.S.); Department of Clinical Operations, Boehringer Ingelheim Regional Center Vienna, Vienna (B.B.); Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (M.A.B.); and Cardiology Department, Miulli Hospital, Acquaviva delle Fonti, Italy (M.G.)
| | - Branislav Biss
- From Johns Hopkins Medical Institutions, Baltimore (H.C.); Department of Cardiology-Electrophysiology, University Heart Center Hamburg, Hamburg (S.W.), Department of Cardiology, J.W. Goethe University, Frankfurt (S.H.H.), and Boehringer Ingelheim Pharma, Ingelheim am Rhein (M.N.) - all in Germany; Section of Cardiac Electrophysiology, University of California, San Francisco, San Francisco (E.P.G.); University of Toronto, Toronto (A.V.); Barts Heart Centre, Saint Bartholomew's Hospital, London (R.S.), and Biometrics and Data Sciences Department, Boehringer Ingelheim, Bracknell (K.G.) - both in the United Kingdom; Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan (K.O.); St. Louis Heart and Vascular, St. Louis (H.S.); Department of Clinical Operations, Boehringer Ingelheim Regional Center Vienna, Vienna (B.B.); Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (M.A.B.); and Cardiology Department, Miulli Hospital, Acquaviva delle Fonti, Italy (M.G.)
| | - Marc A Brouwer
- From Johns Hopkins Medical Institutions, Baltimore (H.C.); Department of Cardiology-Electrophysiology, University Heart Center Hamburg, Hamburg (S.W.), Department of Cardiology, J.W. Goethe University, Frankfurt (S.H.H.), and Boehringer Ingelheim Pharma, Ingelheim am Rhein (M.N.) - all in Germany; Section of Cardiac Electrophysiology, University of California, San Francisco, San Francisco (E.P.G.); University of Toronto, Toronto (A.V.); Barts Heart Centre, Saint Bartholomew's Hospital, London (R.S.), and Biometrics and Data Sciences Department, Boehringer Ingelheim, Bracknell (K.G.) - both in the United Kingdom; Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan (K.O.); St. Louis Heart and Vascular, St. Louis (H.S.); Department of Clinical Operations, Boehringer Ingelheim Regional Center Vienna, Vienna (B.B.); Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (M.A.B.); and Cardiology Department, Miulli Hospital, Acquaviva delle Fonti, Italy (M.G.)
| | - Massimo Grimaldi
- From Johns Hopkins Medical Institutions, Baltimore (H.C.); Department of Cardiology-Electrophysiology, University Heart Center Hamburg, Hamburg (S.W.), Department of Cardiology, J.W. Goethe University, Frankfurt (S.H.H.), and Boehringer Ingelheim Pharma, Ingelheim am Rhein (M.N.) - all in Germany; Section of Cardiac Electrophysiology, University of California, San Francisco, San Francisco (E.P.G.); University of Toronto, Toronto (A.V.); Barts Heart Centre, Saint Bartholomew's Hospital, London (R.S.), and Biometrics and Data Sciences Department, Boehringer Ingelheim, Bracknell (K.G.) - both in the United Kingdom; Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan (K.O.); St. Louis Heart and Vascular, St. Louis (H.S.); Department of Clinical Operations, Boehringer Ingelheim Regional Center Vienna, Vienna (B.B.); Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (M.A.B.); and Cardiology Department, Miulli Hospital, Acquaviva delle Fonti, Italy (M.G.)
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10
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Li PJ, Xiao J, Yang Q, Feng Y, Wang T, Liu GJ, Liang ZA. Network meta-analysis of efficacy and safety of competitive oral anticoagulants in patients undergoing radiofrequency catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 2016; 46:213-24. [PMID: 27001171 DOI: 10.1007/s10840-016-0126-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 03/07/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE The aim of this network meta-analysis was to evaluate the comparative efficacy and safety of dabigatran, rivaroxaban, apixaban, interrupted vitamin K antagonist (I-VKA), and continuous VKA (C-VKA) in patients undergoing radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). METHODS PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched to identify clinical trials comparing dabigatran, rivaroxaban, or apixaban with I-VKA or C-VKA, or against each other, in AF patients undergoing RFCA. A network meta-analysis was conducted to directly and indirectly compare the efficacy and safety of competitive anticoagulation regimens with a Bayesian random-effects model. RESULTS A total of 39 studies enrolling 27,766 patients were included. C-VKA demonstrated significant superiority over I-VKA in reducing thromboembolic events (risk difference [RD] -0.0068, 95 % confidence interval [CI] -0.0106 to -0.0032) and major bleeding complications (RD -0.0044, 95 % CI -0.0098 to -0.0006). Rivaroxaban compared with I-VKA was associated with a lower risk of thromboembolism (RD -0.0073, 95 % CI -0.0134 to -0.0012), being at the best ranking position among all of the compared anticoagulation regimens in terms of both the efficacy and safety. None of the remaining comparisons reached statistically significant difference in the rate of thromboembolism or major bleeding. CONCLUSIONS The present study suggests that C-VKA is superior to I-VKA for AF patients undergoing RFCA. Rivaroxaban is the highest probability to be the optimal alternative to C-VKA among the three non-VKA oral anticoagulants in AF ablation.
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Affiliation(s)
- Pei-Jun Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, People's Republic of China, 610041
| | - Jun Xiao
- Department of Intensive Care Unit, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Qing Yang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Ting Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, People's Republic of China, 610041
| | - Guan-Jian Liu
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Zong-An Liang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, People's Republic of China, 610041.
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11
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Hahne K, Mönnig G, Samol A. Atrial fibrillation and silent stroke: links, risks, and challenges. Vasc Health Risk Manag 2016; 12:65-74. [PMID: 27022272 PMCID: PMC4788372 DOI: 10.2147/vhrm.s81807] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia, with a projected number of 1 million affected subjects in Germany. Changes in age structure of the Western population allow for the assumption that the number of concerned people is going to be doubled, maybe tripled, by the year 2050. Large epidemiological investigations showed that AF leads to a significant increase in mortality and morbidity. Approximately one-third of all strokes are caused by AF and, due to thromboembolic cause, these strokes are often more severe than those caused by other etiologies. Silent brain infarction is defined as the presence of cerebral infarction in the absence of corresponding clinical symptomatology. Progress in imaging technology simplifies diagnostic procedures of these lesions and leads to a large amount of diagnosed lesions, but there is still no final conclusion about frequency, risk factors, and clinical relevance of these infarctions. The prevalence of silent strokes in patients with AF is higher compared to patients without AF, and several studies reported high incidence rates of silent strokes after AF ablation procedures. While treatment strategies to prevent clinically apparent strokes in patients with AF are well investigated, the role of anticoagulatory treatment for prevention of silent infarctions is unclear. This paper summarizes developments in diagnosis of silent brain infarction and its context to AF.
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Affiliation(s)
- Kathrin Hahne
- Division of Cardiology, University Hospital Münster, Münster, Germany
| | - Gerold Mönnig
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Alexander Samol
- Division of Cardiology, University Hospital Münster, Münster, Germany
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12
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Biatrial linear ablation in sustained nonpermanent AF: Results of the substrate modification with ablation and antiarrhythmic drugs in nonpermanent atrial fibrillation (SMAN-PAF) trial. Heart Rhythm 2016; 13:399-406. [DOI: 10.1016/j.hrthm.2015.10.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Indexed: 11/20/2022]
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13
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Shahi V, Brinjikji W, Murad MH, Asirvatham SJ, Kallmes DF. Safety of Uninterrupted Warfarin Therapy in Patients Undergoing Cardiovascular Endovascular Procedures: A Systematic Review and Meta-Analysis. Radiology 2016. [DOI: 10.1148/radiol.2015142531] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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14
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Venous hemostasis postcatheter ablation of atrial fibrillation while under therapeutic levels of oral and intravenous anticoagulation. J Interv Card Electrophysiol 2015. [DOI: 10.1007/s10840-015-0036-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Das M, Wynn GJ, Morgan M, Lodge B, Waktare JEP, Todd DM, Hall MCS, Snowdon RL, Modi S, Gupta D. Recurrence of atrial tachyarrhythmia during the second month of the blanking period is associated with more extensive pulmonary vein reconnection at repeat electrophysiology study. Circ Arrhythm Electrophysiol 2015; 8:846-52. [PMID: 26108982 DOI: 10.1161/circep.115.003095] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 06/18/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Current guidelines recommend a 3-month blanking period after pulmonary vein isolation (PVI) as early recurrence of atrial tachyarrhythmia (ERAT) may be due to transient proarrhythmic factors. However, studies have suggested that these factors resolve by 1 month. PV reconnection (PVrc) is strongly associated with postblanking AT recurrence in paroxysmal atrial fibrillation. We hypothesized that ERAT occurring beyond 4 weeks after PVI is associated with PVrc at repeat electrophysiology study. METHODS AND RESULTS Forty patients with paroxysmal atrial fibrillation underwent mandatory repeat electrophysiology study 2 months after PVI, regardless of symptoms, to document the number of reconnected PVs. Antiarrhythmic drugs, including β-blockers, were discontinued 4 weeks after PVI. Patients were instructed to record a 30-second ECG everyday between the 2 procedures using a portable monitor, with additional recordings for symptoms. ERAT was defined as ≥30 seconds of AT. Patients recorded a total of 3293 ECGs. Four (10%) patients had ERAT in the first 4 weeks (M1) only, 2 (5%) in month 2 (M2) only, and 11 (28%) in both. PVrc of 1 PV was identified in 12 (30%) patients and of >1 PV in 13 (32%) patients. ERAT in M2 was associated with PVrc, whereas M1 was not (11/13 [85%] versus 0/4 [0%]; P=0.006). M2 ERAT was strongly associated with PVrc of >1 PV (10/13 [77%] versus 3/27 [11%] without M2 ERAT; P<0.0001). CONCLUSIONS ERAT occurring beyond 4 weeks after PVI is associated with PVrc and particularly of PVrc of >1 PV. ERAT confined to M1 is unrelated to underlying PVrc. The relationship between ERAT beyond 4 weeks after PVI and postblanking AT recurrence merits further investigation.
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Affiliation(s)
- Moloy Das
- From the Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Gareth J Wynn
- From the Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Maureen Morgan
- From the Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Ben Lodge
- From the Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Johan E P Waktare
- From the Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Derick M Todd
- From the Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mark C S Hall
- From the Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Richard L Snowdon
- From the Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Simon Modi
- From the Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Dhiraj Gupta
- From the Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
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16
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Cappato R, Marchlinski FE, Hohnloser SH, Naccarelli GV, Xiang J, Wilber DJ, Ma CS, Hess S, Wells DS, Juang G, Vijgen J, Hügl BJ, Balasubramaniam R, De Chillou C, Davies DW, Fields LE, Natale A. Uninterrupted rivaroxaban vs. uninterrupted vitamin K antagonists for catheter ablation in non-valvular atrial fibrillation. Eur Heart J 2015; 36:1805-11. [PMID: 25975659 PMCID: PMC4508487 DOI: 10.1093/eurheartj/ehv177] [Citation(s) in RCA: 320] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 04/24/2015] [Indexed: 12/03/2022] Open
Abstract
Aims VENTURE-AF is the first prospective randomized trial of uninterrupted rivaroxaban and vitamin K antagonists (VKAs) in patients with non-valvular atrial fibrillation (NVAF) undergoing catheter ablation (CA). Methods and results Trial size was administratively set at 250, the protocol-specified target. Events were independently and blindly adjudicated. We randomly assigned 248 NVAF patients to uninterrupted rivaroxaban (20 mg once-daily) or to an uninterrupted VKA prior to CA and for 4 weeks afterwards. The primary endpoint was major bleeding events after CA. Secondary endpoints included thromboembolic events (composite of stroke, systemic embolism, myocardial infarction, and vascular death) and other bleeding or procedure-attributable events. Patients were 59.5 ± 10 years of age, 71% male, 74% paroxysmal AF, and had a CHA2DS2-VASc score of 1.6. The average total heparin dose used to manage activated clotting time (ACT) was slightly higher (13 871 vs. 10 964 units; P < 0.001) and the mean ACT level attained slightly lower (302 vs. 332 s; P < 0.001) in rivaroxaban and VKA arms, respectively. The incidence of major bleeding was low (0.4%; 1 major bleeding event). Similarly, thromboembolic events were low (0.8%; 1 ischemic stroke and 1 vascular death). All events occurred in the VKA arm and all after CA. The number of any adjudicated events (26 vs. 25), any bleeding events (21 vs. 18), and any other procedure-attributable events (5 vs. 5) were similar. Conclusion In patients undergoing CA for AF, the use of uninterrupted oral rivaroxaban was feasible and event rates were similar to those for uninterrupted VKA therapy. Name of the Trial Registry Clinicaltrials.gov trial registration number is NCT01729871.
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Affiliation(s)
- Riccardo Cappato
- Arrhythmia and Electrophysiology Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy Gavazzeni Hospital, Second Arrhythmia and EP Unit, Bergamo, Italy
| | - Francis E Marchlinski
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Stefan H Hohnloser
- Department of Cardiology, Division of Clinical Electrophysiology, JW Goethe University, Frankfurt, Germany
| | - Gerald V Naccarelli
- Heart and Vascular Institute, Penn State University College of Medicine, Hershey, PA, USA
| | - Jim Xiang
- Biostatistics and Programming, Janssen Research & Development, LLC, Raritan, NJ, USA
| | - David J Wilber
- Department of Medicine, Cardiovascular Institute, Loyola University, Chicago, IL, USA
| | - Chang-Sheng Ma
- Cardiology Division, Beijing AnZhen Hospital, Capital Medical University (CMU), Beijing, China
| | - Susanne Hess
- Medical Affairs, Bayer Healthcare Pharmaceuticals, Berlin, Germany
| | - Darryl S Wells
- Cardiac Electrophysiology, Swedish Heart & Vascular Institute, Seattle, WA, USA
| | - George Juang
- Heart and Arrhythmia Care of New York, Manhasset, NY, USA
| | - Johan Vijgen
- Division of Cardiac Electrophysiology, Jessa Hospitals, Hasselt, Belgium
| | - Burkhard J Hügl
- Department of Cardiology and Rhythmology, Marienhaus Klinikum St. Elisabeth, Neuwied, Germany
| | | | | | - D Wyn Davies
- Waller Department of Cardiology, St. Mary's Hospital, Imperial College NHS Trust, London, United Kingdom
| | - L Eugene Fields
- Medical Affairs, Janssen Scientific Affairs, LLC, Raritan, NJ, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, 3000 N. I-35, Suite 720, Austin, TX 78705, USA
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17
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Nairooz R, Sardar P, Payne J, Aronow WS, Paydak H. Meta-analysis of major bleeding with uninterrupted warfarin compared to interrupted warfarin and heparin bridging in ablation of atrial fibrillation. Int J Cardiol 2015; 187:426-9. [PMID: 25841141 DOI: 10.1016/j.ijcard.2015.03.376] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/22/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
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18
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Comparison of Outcomes After Cardioversion or Atrial Fibrillation Ablation in Patients With Differing Periprocedural Anticoagulation Regimens. Can J Cardiol 2014; 30:1541-6. [DOI: 10.1016/j.cjca.2014.09.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 09/20/2014] [Accepted: 09/21/2014] [Indexed: 11/23/2022] Open
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19
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Santangeli P, Di Biase L, Natale A. Ablation versus drugs: what is the best first-line therapy for paroxysmal atrial fibrillation? Antiarrhythmic drugs are outmoded and catheter ablation should be the first-line option for all patients with paroxysmal atrial fibrillation: pro. Circ Arrhythm Electrophysiol 2014; 7:739-46. [PMID: 25140019 DOI: 10.1161/circep.113.000629] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Pasquale Santangeli
- From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX (P.S., L.D.B., A.N.); Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA (P.S.); Cardiovascular Division, Albert Einstein School of Medicine at Montefiore Hospital, New York, NY (L.D.B.); and Cardiology Department, University of Foggia, Foggia, Italy (P.S., L.D.B.)
| | - Luigi Di Biase
- From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX (P.S., L.D.B., A.N.); Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA (P.S.); Cardiovascular Division, Albert Einstein School of Medicine at Montefiore Hospital, New York, NY (L.D.B.); and Cardiology Department, University of Foggia, Foggia, Italy (P.S., L.D.B.)
| | - Andrea Natale
- From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX (P.S., L.D.B., A.N.); Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA (P.S.); Cardiovascular Division, Albert Einstein School of Medicine at Montefiore Hospital, New York, NY (L.D.B.); and Cardiology Department, University of Foggia, Foggia, Italy (P.S., L.D.B.).
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20
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GARTON ALEXB, DUDZINSKI JOHN, KOWEY PETERR. Oral Anticoagulant Use Around the Time of Atrial Fibrillation Ablation: A Review of the Current Evidence of Individual Oral Anticoagulant Use for Periprocedural Atrial Fibrillation Ablation Thromboembolic Prophylaxis. J Cardiovasc Electrophysiol 2014; 25:1411-8. [DOI: 10.1111/jce.12546] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 08/14/2014] [Accepted: 08/27/2014] [Indexed: 11/29/2022]
Affiliation(s)
- ALEX B. GARTON
- Division of Cardiovascular Disease; Lankenau Medical Center; Wynnewood Pennsylvania USA
| | - JOHN DUDZINSKI
- Department of Internal Medicine; Lankenau Medical Center; Wynnewood Pennsylvania USA
| | - PETER R. KOWEY
- Division of Cardiovascular Disease; Lankenau Medical Center; Wynnewood Pennsylvania USA
- Department of Internal Medicine; Lankenau Medical Center; Wynnewood Pennsylvania USA
- Jefferson Medical College; Philadelphia Pennsylvania USA
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Winkle RA, Mead RH, Engel G, Kong MH, Patrawala RA. Peri-procedural interrupted oral anticoagulation for atrial fibrillation ablation: comparison of aspirin, warfarin, dabigatran, and rivaroxaban. Europace 2014; 16:1443-9. [PMID: 25115168 PMCID: PMC4178475 DOI: 10.1093/europace/euu196] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Aims Atrial fibrillation ablation requires peri-procedural oral anticoagulation (OAC) to prevent thromboembolic events. There are several options for OAC. We evaluate peri-procedural AF ablation complications using a variety of peri-procedural OACs. Methods and results We examined peri-procedural OAC and groin, bleeding, and thromboembolic complications for 2334 consecutive AF ablations using open irrigated-tip radiofrequency (RF) catheters. Pre-ablation OAC was warfarin in 1113 (47.7%), dabigatran 426 (18.3%), rivaroxaban 187 (8.0%), aspirin 472 (20.2%), and none 136 (5.8%). Oral anticoagulation was always interrupted and intraprocedural anticoagulation was unfractionated heparin (activated clotting time, ACT = 237 ± 26 s). Pre- and post-OAC drugs were the same for 1591 (68.2%) and were different for 743 (31.8%). Following ablation, 693 (29.7%) were treated with dabigatran and 291 (12.5%) were treated with rivaroxaban. There were no problems changing from one OAC pre-ablation to another post-ablation. Complications included 12 (0.51%) pericardial tamponades [no differences for dabigatran (P = 0.457) or rivaroxaban (P = 0.163) compared with warfarin], 12 (0.51%) groin complications [no differences for rivaroxaban (P = 0.709) and fewer for dabigatran (P = 0.041) compared with warfarin]. Only 5 of 2334 (0.21%) required blood transfusions. There were two strokes (0.086%) and no transient ischaemic attacks (TIAs) in the first 48 h post-ablation. Three additional strokes (0.13%), and two TIAs (0.086%) occurred from 48 h to 30 days. Only one stroke had a residual deficit. Compared with warfarin, the neurologic event rate was not different for dabigatran (P = 0.684) or rivaroxaban (P = 0.612). Conclusion Using interrupted OAC, low target intraprocedural ACT, and irrigated-tip RF, the rate of peri-procedural groin, haemorrhagic, and thromboembolic complications was extremely low. There were only minimal differences between OACs. Low-risk patients may remain on aspirin/no OAC pre-ablation. There are no problems changing from one OAC pre-ablation to another post-ablation.
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Affiliation(s)
- Roger A Winkle
- Silicon Valley Cardiology, 1950 University Avenue, Suite 160, East Palo Alto, CA 94303, USA Sequoia Hospital, Redwood City, CA, USA
| | - R Hardwin Mead
- Silicon Valley Cardiology, 1950 University Avenue, Suite 160, East Palo Alto, CA 94303, USA Sequoia Hospital, Redwood City, CA, USA
| | - Gregory Engel
- Silicon Valley Cardiology, 1950 University Avenue, Suite 160, East Palo Alto, CA 94303, USA Sequoia Hospital, Redwood City, CA, USA
| | - Melissa H Kong
- Silicon Valley Cardiology, 1950 University Avenue, Suite 160, East Palo Alto, CA 94303, USA Sequoia Hospital, Redwood City, CA, USA
| | - Rob A Patrawala
- Silicon Valley Cardiology, 1950 University Avenue, Suite 160, East Palo Alto, CA 94303, USA Sequoia Hospital, Redwood City, CA, USA
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Dillier R, Ammar S, Hessling G, Kaess B, Pavaci H, Buiatti A, Semmler V, Kathan S, Hofmann M, Lennerz C, Kolb C, Reents T, Deisenhofer I. Safety of Continuous Periprocedural Rivaroxaban for Patients Undergoing Left Atrial Catheter Ablation Procedures. Circ Arrhythm Electrophysiol 2014; 7:576-82. [DOI: 10.1161/circep.114.001586] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background—
This study aimed to evaluate the safety of continuous periprocedural rivaroxaban administration during left atrial radiofrequency ablation (RFA) in comparison with uninterrupted oral vitamin K antagonist administration. Data about the use of rivaroxaban in the setting of left atrial RFA procedures are lacking.
Methods and Results—
The study cohort included 544 patients (mean age, 63±10 years) who underwent left atrial RFA procedures between February 2012 and May 2013. All patients (n=272) receiving uninterrupted periprocedural rivaroxaban 15 or 20 mg/d before the procedure (rivaroxaban) were matched by age, sex, and type of rhythm disorder with an equal number of patients managed with uninterrupted vitamin K antagonist phenprocoumon (international normalized ratio, 2–3). During RFA, heparin was given intravenously to maintain an activated clotting time at 270 to 300 s. The safety end point was a composite of bleeding, thromboembolic events, and death. There were no thromboembolic complications and no deaths in either group. The prevalence of major bleeding complications was similar in both groups (1 tamponade in RivG and 1 groin hematoma requiring transfusion in phenprocoumon). Minor bleeding complications occurred equally in both groups (20 of 272; 7% in the rivaroxaban versus 33 of 272, 12% in the phenprocoumon;
P
=0.08). In multivariable analyses, female sex was associated with a greater risk of complications (odds ratio, 1.96; 95% confidence interval, 1.10–3.49).
Conclusions—
In patients undergoing left atrial RFA, continuous periprocedural rivaroxaban use seems to be as safe as uninterrupted periprocedural phenprocoumon administration.
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Affiliation(s)
- Roger Dillier
- From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany
| | - Sonia Ammar
- From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany
| | - Gabriele Hessling
- From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany
| | - Bernhard Kaess
- From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany
| | - Herribert Pavaci
- From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany
| | - Alessandra Buiatti
- From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany
| | - Verena Semmler
- From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany
| | - Susanne Kathan
- From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany
| | - Monika Hofmann
- From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany
| | - Carsten Lennerz
- From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany
| | - Christof Kolb
- From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany
| | - Tilko Reents
- From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany
| | - Isabel Deisenhofer
- From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany
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Winkle RA. Uninterrupted warfarin anticoagulation for atrial fibrillation ablation: too good to be true? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:661-4. [PMID: 24766476 DOI: 10.1111/pace.12398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 03/22/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Roger A Winkle
- Silicon Valley Cardiology, East Palo Alto, California, and Sequoia Hospital, Redwood City, California
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Periprocedural Stroke Risk in Patients Undergoing Catheter Ablation for Atrial Fibrillation on Uninterrupted Warfarin. J Cardiovasc Electrophysiol 2014; 25:585-90. [DOI: 10.1111/jce.12411] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 01/07/2014] [Accepted: 01/14/2014] [Indexed: 11/26/2022]
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I Garcia Md L, A Mascarenhas Md M, Ahuja Md K, Aizer Md A, Bernstein Md N, A Bernstein Md S, J Fowler Md S, S Holmes Md D, S Park Md And D, Chinitz Md L. The Safetyof Dabigatran Versus Warfarin in Patients Undergoing Atrial Fibrillation Ablation. J Atr Fibrillation 2014; 6:965. [PMID: 27957036 DOI: 10.4022/jafib.965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 12/28/2013] [Accepted: 01/02/2014] [Indexed: 11/10/2022]
Abstract
The safety and optimal strategy of the use of dabigatran versus uninterrupted warfarin in atrial fibrillation ablation is currently unclear. We performed a retrospective analysis between July 2011-October 2012 of all patients undergoing an AF ablation who received uninterrupted warfarin therapy (199) and the routine cessation of Dabigatran therapy (126) 4 days pre-ablation. Major safety endpoints included: pericardial effusion (requiring pericardiocentesis), peripheral thromboembolism, CVA, and groin hematoma requiring blood transfusion. Minor endpoints included pericardial effusion and groin hematoma. Dabigatran was restarted the following day after ablation. The warfarin group was older, had a higher CHADS2, CHA2DS2VASc and HASBLED scores and greater prevalence of aortic plaque. The major complication rate was 2.0% in the warfarin group and 2.4% in the dabigatran group (P= 0.83). The minor complication rate was 2.5% in the warfarin group and <1% in the dabigatran group (P= 0.27). In the dabigatran group, there was one renal thromboembolic event 4 days post-ablation. All patients in the warfarin group who suffered a major complication required a blood transfusion. Cessation of dabigatran therapy 4 days pre AF ablation has a comparable safety profile to uninterrupted warfarin therapy.
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Affiliation(s)
- Luis I Garcia Md
- The Division of Cardiology, New York University School of Medicine, New York, United States
| | - Mark A Mascarenhas Md
- The Division of Cardiology, New York University School of Medicine, New York, United States
| | - Kartikya Ahuja Md
- The Division of Cardiology, New York University School of Medicine, New York, United States
| | - Anthony Aizer Md
- The Division of Cardiology, New York University School of Medicine, New York, United States
| | - Neil Bernstein Md
- The Division of Cardiology, New York University School of Medicine, New York, United States
| | - Scott A Bernstein Md
- The Division of Cardiology, New York University School of Medicine, New York, United States
| | - Steve J Fowler Md
- The Division of Cardiology, New York University School of Medicine, New York, United States
| | - Douglas S Holmes Md
- The Division of Cardiology, New York University School of Medicine, New York, United States
| | - David S Park Md And
- The Division of Cardiology, New York University School of Medicine, New York, United States
| | - Larry Chinitz Md
- The Division of Cardiology, New York University School of Medicine, New York, United States
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Zhang XD, Gu J, Jiang WF, Zhao L, Zhou L, Wang YL, Liu YG, Liu X. Optimal rhythm-control strategy for recurrent atrial tachycardia after catheter ablation of persistent atrial fibrillation: a randomized clinical trial. Eur Heart J 2014; 35:1327-34. [PMID: 24497338 DOI: 10.1093/eurheartj/ehu017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIM Although catheter ablation (CA) has replaced antiarrhythmic drugs (AAD) as first-line treatment in selected patients with atrial fibrillation (AF), optimal treatment of recurrent atrial tachycardia (AT) after AF ablation remains unclear. This parallel randomized controlled study compared CA vs. AAD for recurrent AT after persistent AF ablation. METHODS AND RESULTS Two-hundred and one patients (aged 59.1 ± 10.9 years, 68.7% male) with recurrent AT after persistent AF ablation were enrolled and randomized to either CA (n = 101) or AAD (n = 100) treatment. Primary endpoint was freedom from recurrent atrial tachyarrhythmia (ATa, including AT and AF) at 24-month follow-up. Composite secondary endpoints comprised procedural complications, long-term morbidity and improvement in quality of life (QoL). On an intention-to-treat basis, the CA group had a higher rate of freedom from recurrent ATa (56.4 vs. 34.0%; P = 0.001). Adjusted Cox regression analysis showed a significant treatment effect with a hazard ratio of 0.538 (95% CI: 0.355-0.816) in favour of CA. There was a higher proportion of periprocedural complications in the CA group (7.9 vs. 0; P = 0.012), and of long-term adverse events in the AAD group (10.9 vs. 24.0%; P = 0.014). Quality of life was significantly higher for CA. CONCLUSIONS This study demonstrates superiority of CA over AAD for recurrent AT after persistent AF ablation with regard to SR maintenance, long-term safety and QoL improvement. However, CA use might be limited by a higher risk for periprocedural complications.
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Affiliation(s)
- Xiao-Dong Zhang
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, 241 West Huaihai Road, Shanghai 200030, China
| | - Jun Gu
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, 241 West Huaihai Road, Shanghai 200030, China
| | - Wei-Feng Jiang
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, 241 West Huaihai Road, Shanghai 200030, China
| | - Liang Zhao
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, 241 West Huaihai Road, Shanghai 200030, China
| | - Li Zhou
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, 241 West Huaihai Road, Shanghai 200030, China
| | - Yuan-Long Wang
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, 241 West Huaihai Road, Shanghai 200030, China
| | - Yu-Gang Liu
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, 241 West Huaihai Road, Shanghai 200030, China
| | - Xu Liu
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, 241 West Huaihai Road, Shanghai 200030, China
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National survey of catheter ablation for atrial fibrillation: The Japanese catheter ablation registry of atrial fibrillation (J-CARAF). J Arrhythm 2013. [DOI: 10.1016/j.joa.2012.12.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Eitel C, Koch J, Sommer P, John S, Kircher S, Bollmann A, Arya A, Piorkowski C, Hindricks G. Novel oral anticoagulants in a real-world cohort of patients undergoing catheter ablation of atrial fibrillation. Europace 2013; 15:1587-93. [DOI: 10.1093/europace/eut128] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Herring N, Page SP, Ahmed M, Burg MR, Hunter RJ, Earley MJ, Sporton SC, Newton JD, Sabharwal NK, Myerson SG, Bashir Y, Betts TR, Schilling RJ, Rajappan K. The Prevalence of Low Left Atrial Appendage Emptying Velocity and Thrombus in Patients Undergoing Catheter Ablation for Atrial Fibrillation on Uninterrupted Peri-procedural Warfarin Therapy. J Atr Fibrillation 2013; 5:761. [PMID: 28496828 DOI: 10.4022/jafib.761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 03/11/2013] [Accepted: 03/16/2013] [Indexed: 01/18/2023]
Abstract
Introduction: The 2012 HRS/EHRA/ECAS guidelines encourage pre-procedural transesophageal echocardiography (TEE) prior to ablation for atrial fibrillation (AF), but acknowledge a lack of consensus in patients maintained on therapeutic warfarin before, during and after the procedure. This is partly because the incidence of left atrial appendage (LAA) thrombus is so low, that it is hard to draw clear conclusion regarding the characteristics of patients who develop thrombus. We hypothesize that the presence of low LAA emptying velocities, which predisposes to thrombus, and/or thrombus itself can be predicted in patients undergoing ablation, based upon clinical characteristics and transthoracic echocardiography (TTE). Methods: In this multicentre study, we undertook TTE and transesophageal echocardiograms (TEE) in 586 patients (age 59.9±0.4 years old, 64.5% male) undergoing catheter ablation for AF who were anticoagulated on warfarin (target international normalized ratio 2-3.5) for ≥3 consecutive weeks prior to procedure and maintained on warfarin for the procedure. Results: Low peak LAA emptying velocities (<40cm/s) were identified in 111 (24.7%) patients and LAA thrombus was identified in 3 patients (0.5%) despite having therapeutic INRs. The 3 patients with thrombus had LAA emptying velocities of 23, 29 and 31 cm/s. None of the remaining patients had a peri-procedural stroke. Patients with peak LAA emptying velocities <40cm/s or thrombus on TEE had significantly (p<0.05) higher CHA2DS2-VASc scores (1.7± 0.1 v's 1.4±0.1), and were more likely to have impaired LVSF (odds ratio [95% CI]: 2.66 [1.52-4.66]), a LA diameter >4.6cm on TTE (2.40 [2.13-5.41]), or persistent AF (2.60 [1.63-4.14]) compared to those with a higher LAA velocity without thrombus. Conclusion: In patients on uninterrupted warfarin therapy, a CHA2DS2-VASc score ≥1 or LA diameter >4.6cm on TTE identifies 91.5% of those at risk of developing thrombus with LAA emptying velocity of <40 cm/s and 100% of those with thrombus in our cohort.
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Affiliation(s)
- Neil Herring
- Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK and
| | - Stephen P Page
- Barts and the London Cardiovascular Biomedical Research Unit, London, UK
| | - Mohammed Ahmed
- Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK and
| | - Melanie R Burg
- Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK and
| | - Ross J Hunter
- Barts and the London Cardiovascular Biomedical Research Unit, London, UK
| | - Mark J Earley
- Barts and the London Cardiovascular Biomedical Research Unit, London, UK
| | - Simon C Sporton
- Barts and the London Cardiovascular Biomedical Research Unit, London, UK
| | - James D Newton
- Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK and
| | | | - Saul G Myerson
- Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK and
| | - Yaver Bashir
- Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK and
| | - Tim R Betts
- Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK and
| | | | - Kim Rajappan
- Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK and
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Santangeli P, Di Biase L, Burkhardt JD, Natale A. Catheter ablation of atrial fibrillation under therapeutic warfarin should be adopted worldwide: let's stop waiting for Godot! J Cardiovasc Electrophysiol 2013; 24:516-8. [PMID: 23421469 DOI: 10.1111/jce.12092] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Actualización detallada de las guías de la ESC para el manejo de la fibrilación auricular de 2012. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Kwong WJ, Kamat S, Fang C. Resource Use and Cost Implications of Switching Among Warfarin Formulations in Atrial Fibrillation Patients. Ann Pharmacother 2012; 46:1609-16. [DOI: 10.1345/aph.1q472] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Despite the uncertainty surrounding the safety of switching warfarin formulations, limited data exist on the resource use and costs associated with this switching pattern. Objective: To evaluate health care resource use and costs associated with switching warfarin formulations among patients with atrial fibrillation (AF) in a managed care organization. Methods: Patients diagnosed with AF (ICD-9 427.31) between July 2004 and August 2008 and who received warfarin therapy were identified in the HealthCore Integrated Research Database and categorized into 3 groups: users of generic warfarin formulations from a single drug manufacturer (generic-only group), users of branded warfarin formulations only (brand-only group), and patients who used generic and branded warfarin therapy interchangeably or who may have used generic drugs from 1 or more manufacturers (generic/brand switching group). Patients were followed 12 months or longer after their index warfarin prescription date to compare all-cause resource use and costs using multivariable regression analysis. Results: The analysis included 12,908 patients: 71.82% were in the generic-only group, 9.61% were in the brand-only group, and 18.57% were in the generic/brand switching group. Patients in the generic/brand switching group were more likely to be hospitalized (relative risk [RR] = 1.43, p < 0.0001) or to use emergency department services (RR = 1.20, p < 0.01), compared to the brand-only users. Hospitalizations were more likely (RR = 1.26, p < 0.001) to occur among generic-only users versus brand-only users. Adjusted mean pharmacy costs per member per month were lower in the generic/brand switching group compared to the brand-only group ($257 vs $273, p = 0.038), but inpatient costs were higher ($1250 vs $972, p < 0.001), resulting in higher ($2125 vs $1847, p < 0.001) total costs. Generic-only users had lower pharmacy costs compared to brand-only users ($246 vs $273, p < 0.001), but total health care costs trended to be higher in the generic-only group ($1957 vs $1847, p = 0.053). Conclusions: The use of both generic and branded formulations of warfarin interchangeably, or the use of generics from more than 1 manufacturer, was associated with increased use of all-cause health care resources and total costs in patients with AF.
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Naccarelli GV, Gonzalez MD. Catheter ablation of atrial fibrillation: the need for studies to assess the efficacy and safety of novel anticoagulants. J Interv Card Electrophysiol 2012; 36:3-4. [PMID: 23054126 DOI: 10.1007/s10840-012-9720-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 07/31/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Gerald V Naccarelli
- Electrophysiology Program, Heart and Vascular Institute, Penn State University College of Medicine, 500 University Drive, Room H1511, P. O. Box 850, MC H047, Hershey, PA 17033, 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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Epicardial catheter ablation for ventricular tachycardia in heparinized patients. Europace 2012; 15:284-9. [DOI: 10.1093/europace/eus258] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Camm AJ, Lip GYH, De Caterina R, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Ž, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Vardas P, Al-Attar N, Alfieri O, Angelini A, Blömstrom-Lundqvist C, Colonna P, De Sutter J, Ernst S, Goette A, Gorenek B, Hatala R, Heidbüchel H, Heldal M, Kristensen SD, Kolh P, Le Heuzey JY, Mavrakis H, Mont L, Filardi PP, Ponikowski P, Prendergast B, Rutten FH, Schotten U, Van Gelder IC, Verheugt FW. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 2012; 33:2719-47. [PMID: 22922413 DOI: 10.1093/eurheartj/ehs253] [Citation(s) in RCA: 2368] [Impact Index Per Article: 197.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- A John Camm
- Division of Clinical Sciences, St.George’s University of London, Cranmer Terrace, London SW17 0RE, United Kingdom.
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Camm AJ, Lip GYH, De Caterina R, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation--developed with the special contribution of the European Heart Rhythm Association. Europace 2012; 14:1385-413. [PMID: 22923145 DOI: 10.1093/europace/eus305] [Citation(s) in RCA: 955] [Impact Index Per Article: 79.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- A John Camm
- Division of Clinical Sciences, St.George's University of London, Cranmer Terrace, London SW17 0RE, United Kingdom.
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2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. J Interv Card Electrophysiol 2012; 33:171-257. [PMID: 22382715 DOI: 10.1007/s10840-012-9672-7] [Citation(s) in RCA: 256] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This is a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation, developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology and the European Cardiac Arrhythmia Society (ECAS), and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). This is endorsed by the governing bodies of the ACC Foundation, the AHA, the ECAS, the EHRA, the STS, the APHRS, and the HRS.
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Santangeli P, Di Biase L, Horton R, Burkhardt JD, Sanchez J, Al-Ahmad A, Hongo R, Beheiry S, Bai R, Mohanty P, Lewis WR, Natale A. Ablation of Atrial Fibrillation Under Therapeutic Warfarin Reduces Periprocedural Complications. Circ Arrhythm Electrophysiol 2012; 5:302-11. [DOI: 10.1161/circep.111.964916] [Citation(s) in RCA: 145] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Pasquale Santangeli
- From the Texas Cardiac Arrhythmia Institute (P.S., L.D.B., R.H., D.B., J.S., R.B., P.M., A.N.), St David's Medical Center, and Department of Biomedical Engineering (L.D.B., A.N.), University of Texas, Austin, TX; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B.); Division of Cardiology, Stanford University, Stanford, CA (A.A.-A., A.N.); California Pacific Medical Center, San Francisco, CA (R.H., S.B., A.N.); and Case Western Reserve University School of Medicine, Cleveland, OH
| | - Luigi Di Biase
- From the Texas Cardiac Arrhythmia Institute (P.S., L.D.B., R.H., D.B., J.S., R.B., P.M., A.N.), St David's Medical Center, and Department of Biomedical Engineering (L.D.B., A.N.), University of Texas, Austin, TX; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B.); Division of Cardiology, Stanford University, Stanford, CA (A.A.-A., A.N.); California Pacific Medical Center, San Francisco, CA (R.H., S.B., A.N.); and Case Western Reserve University School of Medicine, Cleveland, OH
| | - Rodney Horton
- From the Texas Cardiac Arrhythmia Institute (P.S., L.D.B., R.H., D.B., J.S., R.B., P.M., A.N.), St David's Medical Center, and Department of Biomedical Engineering (L.D.B., A.N.), University of Texas, Austin, TX; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B.); Division of Cardiology, Stanford University, Stanford, CA (A.A.-A., A.N.); California Pacific Medical Center, San Francisco, CA (R.H., S.B., A.N.); and Case Western Reserve University School of Medicine, Cleveland, OH
| | - J. David Burkhardt
- From the Texas Cardiac Arrhythmia Institute (P.S., L.D.B., R.H., D.B., J.S., R.B., P.M., A.N.), St David's Medical Center, and Department of Biomedical Engineering (L.D.B., A.N.), University of Texas, Austin, TX; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B.); Division of Cardiology, Stanford University, Stanford, CA (A.A.-A., A.N.); California Pacific Medical Center, San Francisco, CA (R.H., S.B., A.N.); and Case Western Reserve University School of Medicine, Cleveland, OH
| | - Javier Sanchez
- From the Texas Cardiac Arrhythmia Institute (P.S., L.D.B., R.H., D.B., J.S., R.B., P.M., A.N.), St David's Medical Center, and Department of Biomedical Engineering (L.D.B., A.N.), University of Texas, Austin, TX; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B.); Division of Cardiology, Stanford University, Stanford, CA (A.A.-A., A.N.); California Pacific Medical Center, San Francisco, CA (R.H., S.B., A.N.); and Case Western Reserve University School of Medicine, Cleveland, OH
| | - Amin Al-Ahmad
- From the Texas Cardiac Arrhythmia Institute (P.S., L.D.B., R.H., D.B., J.S., R.B., P.M., A.N.), St David's Medical Center, and Department of Biomedical Engineering (L.D.B., A.N.), University of Texas, Austin, TX; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B.); Division of Cardiology, Stanford University, Stanford, CA (A.A.-A., A.N.); California Pacific Medical Center, San Francisco, CA (R.H., S.B., A.N.); and Case Western Reserve University School of Medicine, Cleveland, OH
| | - Richard Hongo
- From the Texas Cardiac Arrhythmia Institute (P.S., L.D.B., R.H., D.B., J.S., R.B., P.M., A.N.), St David's Medical Center, and Department of Biomedical Engineering (L.D.B., A.N.), University of Texas, Austin, TX; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B.); Division of Cardiology, Stanford University, Stanford, CA (A.A.-A., A.N.); California Pacific Medical Center, San Francisco, CA (R.H., S.B., A.N.); and Case Western Reserve University School of Medicine, Cleveland, OH
| | - Salwa Beheiry
- From the Texas Cardiac Arrhythmia Institute (P.S., L.D.B., R.H., D.B., J.S., R.B., P.M., A.N.), St David's Medical Center, and Department of Biomedical Engineering (L.D.B., A.N.), University of Texas, Austin, TX; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B.); Division of Cardiology, Stanford University, Stanford, CA (A.A.-A., A.N.); California Pacific Medical Center, San Francisco, CA (R.H., S.B., A.N.); and Case Western Reserve University School of Medicine, Cleveland, OH
| | - Rong Bai
- From the Texas Cardiac Arrhythmia Institute (P.S., L.D.B., R.H., D.B., J.S., R.B., P.M., A.N.), St David's Medical Center, and Department of Biomedical Engineering (L.D.B., A.N.), University of Texas, Austin, TX; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B.); Division of Cardiology, Stanford University, Stanford, CA (A.A.-A., A.N.); California Pacific Medical Center, San Francisco, CA (R.H., S.B., A.N.); and Case Western Reserve University School of Medicine, Cleveland, OH
| | - Prasant Mohanty
- From the Texas Cardiac Arrhythmia Institute (P.S., L.D.B., R.H., D.B., J.S., R.B., P.M., A.N.), St David's Medical Center, and Department of Biomedical Engineering (L.D.B., A.N.), University of Texas, Austin, TX; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B.); Division of Cardiology, Stanford University, Stanford, CA (A.A.-A., A.N.); California Pacific Medical Center, San Francisco, CA (R.H., S.B., A.N.); and Case Western Reserve University School of Medicine, Cleveland, OH
| | - William R. Lewis
- From the Texas Cardiac Arrhythmia Institute (P.S., L.D.B., R.H., D.B., J.S., R.B., P.M., A.N.), St David's Medical Center, and Department of Biomedical Engineering (L.D.B., A.N.), University of Texas, Austin, TX; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B.); Division of Cardiology, Stanford University, Stanford, CA (A.A.-A., A.N.); California Pacific Medical Center, San Francisco, CA (R.H., S.B., A.N.); and Case Western Reserve University School of Medicine, Cleveland, OH
| | - Andrea Natale
- From the Texas Cardiac Arrhythmia Institute (P.S., L.D.B., R.H., D.B., J.S., R.B., P.M., A.N.), St David's Medical Center, and Department of Biomedical Engineering (L.D.B., A.N.), University of Texas, Austin, TX; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B.); Division of Cardiology, Stanford University, Stanford, CA (A.A.-A., A.N.); California Pacific Medical Center, San Francisco, CA (R.H., S.B., A.N.); and Case Western Reserve University School of Medicine, Cleveland, OH
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Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, Crijns HJG, Damiano RJ, Davies DW, DiMarco J, Edgerton J, Ellenbogen K, Ezekowitz MD, Haines DE, Haissaguerre M, Hindricks G, Iesaka Y, Jackman W, Jalife J, Jais P, Kalman J, Keane D, Kim YH, Kirchhof P, Klein G, Kottkamp H, Kumagai K, Lindsay BD, Mansour M, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Nakagawa H, Natale A, Nattel S, Packer DL, Pappone C, Prystowsky E, Raviele A, Reddy V, Ruskin JN, Shemin RJ, Tsao HM, Wilber D. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace 2012; 14:528-606. [PMID: 22389422 DOI: 10.1093/europace/eus027] [Citation(s) in RCA: 1144] [Impact Index Per Article: 95.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, Crijns HJG, Damiano RJ, Davies DW, DiMarco J, Edgerton J, Ellenbogen K, Ezekowitz MD, Haines DE, Haissaguerre M, Hindricks G, Iesaka Y, Jackman W, Jalife J, Jais P, Kalman J, Keane D, Kim YH, Kirchhof P, Klein G, Kottkamp H, Kumagai K, Lindsay BD, Mansour M, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Nakagawa H, Natale A, Nattel S, Packer DL, Pappone C, Prystowsky E, Raviele A, Reddy V, Ruskin JN, Shemin RJ, Tsao HM, Wilber D. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Heart Rhythm 2012; 9:632-696.e21. [PMID: 22386883 DOI: 10.1016/j.hrthm.2011.12.016] [Citation(s) in RCA: 1299] [Impact Index Per Article: 108.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Indexed: 12/20/2022]
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Current world literature. Curr Opin Cardiol 2011; 27:62-5. [PMID: 22146379 DOI: 10.1097/hco.0b013e32834f4ed9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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