Safety and Convenience of Continuous Warfarin Strategy During the Periprocedural Period in Patients Who Underwent Catheter Ablation of Atrial Fibrillation

Continuous Warfarin Before AF Ablation. Background: We investigated the efficiency and convenience of a continuous warfarinization (CW) strategy during the periprocedural period of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) in comparison with the classic strategy of switching to heparin (SH).

Methods and Results: We compared CW (n = 49) and SH (n = 55, 3 days before RFCA) in 104 patients who underwent RFCA of AF (77 males, 55 ± 12 years old, paroxysmal AF: persistent AF = 63:41). During the procedure, the activated clotting time (ACT) was maintained between 350 and 400 seconds, and a requirement of H, postablation INR, and periprocedural complications were compared. Results were as follows: (1) in the CW group, the preprocedural INR (1.85 ± 0.61 vs 1.05 ± 0.12, P < 0.001) and the proportions of INR > 2.0 after RFCA (1st postprocedure day 61.2% vs 5.5%, P < 0.001; 2nd postprocedure day 83.3% vs 21.8%, P < 0.005) were higher, and the heparin requirement was lower (2012 ± 998 U/30 minutes vs 2921 ± 795 U/30 minutes, P < 0.001) than in the SH group. (2) The incidences of hemorrhagic complications (18.2% vs 18.4%, P = NS) or the major bleeding rates (reduced hemoglobin ≥ 4 g/dL, requiring blood transfusion; 3.6% vs 12.2%, P = NS) were not significantly different in the CW group than in the SH group.

Conclusion: The periprocedural CW strategy maintains a more stable INR immediately after AF ablation without increasing hemorrhagic complications compared with the classic strategy of SH. Simple CW can replace SH in an experienced laboratory with a low risk of hemopericardium during AF ablation. (J Cardiovasc Electrophysiol, Vol. 21, pp. 620-625, June 2010)