Catheter ablation of atrial fibrillation in patients with therapeutic oral anticoagulation treatment

Hakalahti, Antti; Uusimaa, Paavo; Ylitalo, Kari; Raatikainen, M.J. Pekka

doi:10.1093/europace/eur038

Cited by 70 publications

(32 citation statements)

References 23 publications

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“…In the patients treated with non-vitamin K antagonist oral anticoagulants, the last dose was administered 24 h before the procedure, and the therapy was reintroduced up to 6 h after the procedure. Antithrombotic treatment with heparin was conducted in accordance with the typical scheme, with the monitoring of activated clotting tine, without reversing the effect of heparin at the end of the procedure [4,5]. …”

Section: Methodsmentioning

confidence: 99%

“Buddy wire” for facilitation of femoral venous access for cryoablation: a preliminary report

et al. 2017

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A b s t r a c tBackground: Some electrophysiological techniques, such as balloon cryoablation, involve the use of steerable sheaths of large diameter (outer diameter 15 Fr or more). Their introduction to the femoral vein may be difficult, especially in patients who have had numerous venipunctures in this area. Aim:The authors describe a modification of typical venous access with the use of a "buddy wire" technique, facilitating the insertion of the cryoablation sheaths to the femoral vein. Methods:A case-control study. The study involved a retrospective analysis of 27 consecutive procedures of balloon cryoablation of pulmonary veins performed in 2015 by the first author, compared to 23 consecutive procedures of balloon cryoablation performed in 2014 without a "buddy wire" technique. The study and control groups did not vary significantly. There were 11 women in both groups. The average age of the patients was 55.9 years. The "buddy wire" technique was the only difference in procedure performance between the control and study groups. In the study group a short introducer was inserted through a puncture of the right femoral vein, and then two wires were introduced through it. One of them was secured, so that it could not move, while the other served as a typical trans-septal puncture monitored with the use of X-ray. The standard trans-septal sheet was replaced with a 15 Fr steerable sheath, inserted through the same puncture site next to the secured "buddy wire". The short wire was then removed from the femoral vein. Typical balloon cryoablation of pulmonary veins was performed. After the end of the procedure, the puncture site was secured with a haemostatic suture for 12-18 h. Results:Femoral access with a 15 Fr steerable sheath and cryoablation were safely performed in all patients in the study group and in 22 out of 23 in the control group (100% vs. 95.6%, p = NS). Pulmonary vein isolation in one patient was performed using another technique. No damage to steerable sheaths was observed. There were no vascular complications requiring extended hospitalisation, blood transfusion, or surgical interventions in either group. The "door-to-door" time of the procedures ranged from 2 h 32 min on average in the study group to 2 h 43 min on average in the control group (p = NS). There was significant reduction in fluoroscopy time: 7 min 15 s on average from 11 min 25 s (p = 0.0009). Conclusions:The use of the "buddy wire" technique may lead to significant reduction in fluoroscopy time during cryoablation of pulmonary veins by facilitating the insertion of the steerable sheaths to the femoral vein.

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Section: Methodsmentioning

confidence: 99%

“Buddy wire” for facilitation of femoral venous access for cryoablation: a preliminary report

et al. 2017

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“…Subsequent data emerged that showed that bleeding complications were actually lower with uninterrupted warfarin compared with a bridging strategy. [37][38][39][40] In addition, uninterrupted strategies reduce both clinical and silent thromboembolic events. 41 This pattern of withholding anticoagulation around the time of the ablation also applied to the direct anticoagulants, with some studies advocating bridging and others not.…”

Section: Anticoagulationmentioning

confidence: 99%

Ablation of Atrial Fibrillation

2016

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Atrial fibrillation (AF) is the most common arrhythmia encountered by cardiologists and is a major cause of morbidity and mortality. Risk factors for AF include age, male sex, genetic predisposition, hypertension, diabetes mellitus, sleep apnea, obesity, excessive alcohol, smoking, hyperthyroidism, pulmonary disease, air pollution, heart failure, and possibly excessive exercise. The management of AF involves decisions about rate versus rhythm control. Asymptomatic patients are generally managed with rate control and anticoagulation. Symptomatic patients will desire rhythm control. Rhythm control options are either antiarrhythmic agents or ablation, with each having its own risks and benefits. Ablation of AF has evolved from a rare and complex procedure to a common electrophysiological technique. Selection of patients to undergo ablation is an important aspect of AF care. Patients with the highest success rates of ablation are those with normal structural hearts and paroxysmal AF, although those with congestive heart failure have the greatest potential benefit of the procedure. Although pulmonary vein isolation of any means/energy source is the approach generally agreed on for those with paroxysmal AF, optimal techniques for the ablation of nonparoxysmal AF are not yet clear. Anticoagulation reduces thromboembolic complications; the newer anticoagulants have eased management for both the patient and the cardiologist. Aggressive management of modifiable risk factors (hypertension, diabetes mellitus, sleep apnea, obesity, excessive alcohol, smoking, hyperthyroidism, pulmonary disease, air pollution, and possibly excessive exercise) after ablation reduces the odds of recurrent AF and is an important element of care.

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“…Evidence that intraprocedural intracardiac echocardiography (ICE) reduces major bleeding complications when ablation is performed on therapeutic warfarin. 33,[37][38][39][40][41][42][43][44] Adapted from Santangeli et al 32 with permission of the publisher. Copyright © 2012, American Heart Association.…”

Section: Cost-effectiveness Of Ca As a First-line Therapy For Afmentioning

confidence: 99%

Ablation Versus Drugs: What Is the Best First-Line Therapy for Paroxysmal Atrial Fibrillation?

Biase

2014

Circ: Arrhythmia and Electrophysiology

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Catheter ablation of atrial fibrillation in patients with therapeutic oral anticoagulation treatment

Abstract: Transseptal puncture and AF ablation can be performed safely in patients with ongoing OAT without intracardiac echocardiographic guidance and ACT monitoring.

Cited by 70 publications

References 23 publications

“Buddy wire” for facilitation of femoral venous access for cryoablation: a preliminary report

“Buddy wire” for facilitation of femoral venous access for cryoablation: a preliminary report

Ablation of Atrial Fibrillation

Ablation Versus Drugs: What Is the Best First-Line Therapy for Paroxysmal Atrial Fibrillation?

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