Clinical Impact of Heparin Kinetics During Catheter Ablation of Atrial Fibrillation: Meta‐Analysis and Meta‐Regression

Briceño, David; Villablanca, Pedro A.; Lupercio, Florentino; Kargoli, M.P.H. Faraj; Jagannath, Anand; Londoño, Alejandra; Patel, Jignesh; Otusanya, Olufisayo; Brevik, Jeannine; Maraboto, Carola; Berardi, Cecilia; Krumerman, Andrew; Palma, Eugen C.; Kim, Soo G.; Natale, Andrea; Biase, Luigi Di

doi:10.1111/jce.12975

Cited by 59 publications

(53 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Conversely, less than 5% of all ACT measurements had an ACT greater than 450 seconds found in the present study. Numerous algorithms for ACT‐guided heparinization during the ablation procedure have been reported . The present study did not primarily aim to clarify the ideal protocol of ACT‐guided heparinization; thus, it does not apparently have sufficient data to clarify which algorithm including ours is ideal for heparinization during the procedure.…”

Section: Discussionmentioning

confidence: 93%

“…Our findings of an absence of thromboembolic events and an acceptably low incidence of bleeding events further support the appropriateness of our algorithm of heparin administration based on ACT measurements. A target ACT greater than 300 seconds has been recommended in previous studies, guidelines, and meta‐analysis . Different methods of determining heparin dosing have been reported, including the use of bolus or bolus+infusion methods and various initial bolus doses .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Activated clotting time on the day of atrial fibrillation ablation for minimally interrupted and uninterrupted direct oral anticoagulation therapy: Sequential changes, differences among direct oral anticoagulants, and ablation safety outcomes

Yamaji

Murakami

Hina

et al. 2019

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Background Activated clotting time (ACT)–guided heparinization is used during atrial fibrillation (AF) ablation. Differences in sensitivity to ACT assays have been identified among different direct oral anticoagulants (DOACs). Objective We aimed to examine ACT just before ablation (pre‐ACT) for different ablation start times (9:00, 11:00, 13:00, or 15:00) and ablation safety outcomes in minimally interrupted (min‐Int) and uninterrupted (Unint) DOAC regimens and examine differences in pre‐ACT values among four DOACs. Methods Consecutive patients were randomized into the min‐Int (n = 307) or Unint (n = 277) groups. DOACs examined were apixaban, dabigatran, edoxaban, and rivaroxaban. Results No sequential changes in pre‐ACT values were observed for each DOAC used and for all four DOACs combined in the min‐Int and Unint groups. There was no meaningful difference in pre‐ACT at each ablation start time between the groups. Clinically significant differences in overall pre‐ACT were not obtained between the groups (138 ± 24 vs 142 ± 23 seconds). The pre‐ACT (baseline) value for dabigatran was on average 29 seconds higher than that for the other three DOACs. The min‐Int and Unint groups showed similar thromboembolic (0% vs 0%) and bleeding event rates (major, 1% vs 0%; all, 3.5% vs 2.5%). Conclusion The pre‐ACT did not show a sequential change in the min‐Int and Unint groups. No notable differences in the time‐dependent change in pre‐ACT between the groups were observed. Variations in baseline ACT suggest the need for moderate adjustment of ACT for adequate modification of heparin dose for the other three DOACs. Both regimens provided similar acceptable AF ablation safety outcomes.

show abstract

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Activated clotting time on the day of atrial fibrillation ablation for minimally interrupted and uninterrupted direct oral anticoagulation therapy: Sequential changes, differences among direct oral anticoagulants, and ablation safety outcomes

Yamaji

Murakami

Hina

et al. 2019

Cardiovasc electrophysiol

View full text Add to dashboard Cite

show abstract

“…Third, UFH effect on the ACT varies according to the uninterrupted oral anticoagulant. DOAC‐treated patients required more UFH and reached the ACT target ≥300 seconds later compared with VKA . Furthermore, UFH effect on the ACT also varies according to the DOAC agent.…”

Section: Discussionmentioning

confidence: 99%

Periprocedural management of anticoagulation for atrial fibrillation catheter ablation in direct oral anticoagulant–treated patients

Lessire

Leblanc

Dincq

et al. 2018

Clinical Cardiology

View full text Add to dashboard Cite

Our data showed that uninterrupted DOAC therapy resulted in an unpredictable and highly variable initial level of anticoagulation before catheter ablation. Moreover, even with DOAC interruption preventing interference between DOAC, UFH, and ACT, intraprocedural UFH monitoring was complex. Altogether, our exploratory results call into question the appropriateness of transposing UFH dose protocols, as well as the relevance of ACT monitoring in uninterrupted DOAC-treated patients.

show abstract

“…However, as shown previously by the results of a meta‐analysis provided by Briceno et al, the risk of bleeding events for both NOACs and VKA is not increased when using peri‐interventional heparin administration with target ACT levels >300 s during ablation procedures. In fact, these target ACT levels are associated with lower thromboembolic events …”

Section: Discussionmentioning

confidence: 99%

Apixaban, rivaroxaban, and dabigatran use in patients undergoing catheter ablation for atrial fibrillation using the second‐generation cryoballoon

Tscholl

Lsharaf

Lin

et al. 2017

Clinical Cardiology

View full text Add to dashboard Cite

Background Data are limited on the safety of periprocedural anticoagulation with novel oral anticoagulants (NOACs) in patients undergoing pulmonary vein isolation (PVI) using the second‐generation cryoballoon (CB) for the treatment of atrial fibrillation. Hypothesis We hypothesized that the incidence of acute periprocedural complications in patients undergoing PVI do not differ between patients treated with VKA compared to NOACs. Methods In 200 consecutive patients (mean age, 64.3 _ 10.6 years; female, n = 83) with symptomatic atrial fibrillation, PVI using the second‐generation 28‐mm CB was performed. In patients treated with NOACs, the medication was stopped the day of the procedure and continued the evening after the procedure with a reduced dosage. Patients treated with phenprocoumon were continued on uninterrupted phenprocoumon with a target INR of 2 to 3. If INR was <2, bridging with low‐molecular‐weight heparin was performed. Results Forty‐seven of 200 patients (23.5%) were treated with a vitamin K antagonist (VKA) and 55 (27.5%) were treated with apixaban, 67 (33.5%) with rivaroxaban, and 31 (15.5%) with dabigatran. Seven (3.5%) major complications occurred in the overall population. Major bleeding complications did not differ significantly between the 2 groups (P = 0.23). One patient taking VKA had a pericardial tamponade at the end of the procedure; 2 patients treated with apixaban developed a groin hematoma requiring surgical intervention. Transient ischemic attack occurred in 1 patient of the apixaban and rivaroxaban group. Conclusions Apixaban, rivaroxaban, and dabigatran, compared with uninterrupted VKA, did not show a higher risk for major bleeding or ischemic complications in patients undergoing PVI using the second‐generation CB.

show abstract

Clinical Impact of Heparin Kinetics During Catheter Ablation of Atrial Fibrillation: Meta‐Analysis and Meta‐Regression

Abstract: Performing CA-AF with a target ACT > 300 decreases the risk of TE without increasing the risk of bleeding. Patients receiving VKAs required less heparin and reached the target ACT faster compared to NOACs.

Cited by 59 publications

References 36 publications

Activated clotting time on the day of atrial fibrillation ablation for minimally interrupted and uninterrupted direct oral anticoagulation therapy: Sequential changes, differences among direct oral anticoagulants, and ablation safety outcomes

Activated clotting time on the day of atrial fibrillation ablation for minimally interrupted and uninterrupted direct oral anticoagulation therapy: Sequential changes, differences among direct oral anticoagulants, and ablation safety outcomes

Periprocedural management of anticoagulation for atrial fibrillation catheter ablation in direct oral anticoagulant–treated patients

Apixaban, rivaroxaban, and dabigatran use in patients undergoing catheter ablation for atrial fibrillation using the second‐generation cryoballoon

Contact Info

Product

Resources

About