Dabigatran vs warfarin for radiofrequency catheter ablation of atrial fibrillation

Jin-Seok Kim, Fei She, Krit Jongnarangsin, Aman Chugh, Rakesh Latchamsetty, Hamid Ghanbari, Thomas Crawford, Arisara Suwanagool, Mohammed Sinno, Thomas Carrigan, Robert Kennedy, Wouter Saint-Phard, Miki Yokokawa, Eric Good, Frank Bogun, Frank Pelosi, Fred Morady, Hakan Oral

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Abstract

Background: It is not clear whether dabigatran is as safe and effective as uninterrupted anticoagulation with warfarin during radiofrequency catheter ablation (RFA) of atrial fibrillation (AF). Objective: To compare the safety and efficacy of dabigatran by using a novel administration protocol and uninterrupted anticoagulation with warfarin for periprocedural anticoagulation in patients undergoing RFA of AF. Methods: In this case-control analysis, 763 consecutive patients (mean age 61±10 years) underwent RFA of AF using dabigatran (N = 191) or uninterrupted warfarin (N = 572) for periprocedural anticoagulation. In all patients, anticoagulation was started≥4 weeks before RFA. Dabigatran was held after the morning dose on the day before the procedure and resumed 4 hours after vascular hemostasis was achieved. Results: A transesophageal echocardiogram performed in all patients receiving dabigatran did not demonstrate an intracardiac thrombus. There were no thromboembolic complications in either group. The prevalence of major (4 of 191, 2.1%) and minor (5 of 191, 2.6%) bleeding complications in the dabigatran group were similar to those in the warfarin group (12 of 572, 2.1%; P = 1.0 and 19 of 572, 3.3%; P =.8, respectively). Pericardial tamponade occurred in 2 of 191 (1%) patients in the dabigatran group and in 7 of 572 (1.2%) patients in the warfarin group (P = 1.0). All patients who had a pericardial tamponade, including 2 in the dabigatran group, had uneventful recovery after perdicardiocentesis. On multivariate analysis, international normalized ratio (odds ratio [OR] 4.0; 95% confidence interval [CI] 1.1-15.0; P =.04), clopidogrel use (OR 4.2; 95% CI 1.5-12.3; P =.01), and CHA2DS2-VASc score (OR 1.4; 95% CI 1.1-1.8; P =.01) were the independent risk factors of bleeding complications only in the warfarin group. Conclusions: When held for approximately 24 hours before the procedure and resumed 4 hours after vascular hemostasis, dabigatran appears to be as safe and effective as uninterrupted warfarin for periprocedural anticoagulation in patients undergoing RFA of AF.

Original languageEnglish
Pages (from-to)483-489
Number of pages7
JournalHeart Rhythm
Volume10
Issue number4
DOIs
Publication statusPublished - 2013 Apr 1
Externally publishedYes

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Keywords

  • Atrial fibrillation
  • Bleeding
  • Catheter ablation
  • Dabigatran
  • Warfarin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Kim, J-S., She, F., Jongnarangsin, K., Chugh, A., Latchamsetty, R., Ghanbari, H., Crawford, T., Suwanagool, A., Sinno, M., Carrigan, T., Kennedy, R., Saint-Phard, W., Yokokawa, M., Good, E., Bogun, F., Pelosi, F., Morady, F., & Oral, H. (2013). Dabigatran vs warfarin for radiofrequency catheter ablation of atrial fibrillation. Heart Rhythm, 10(4), 483-489. https://doi.org/10.1016/j.hrthm.2012.12.011