Periprocedural Management of Cardiac Tamponade During Catheter Ablation for AF Under Uninterrupted DOAC and Warfarin

Inden, Yasuya; Ohguchi, Shiou; Nagao, Tomoyuki; Fujii, Aya; Tomomatsu, Toshiro; Mamiya, Keita; Okamoto, Hiroya; Sakamoto, Yusuke; Shibata, Rei; Murohara, Toyoaki

doi:10.1016/j.jacep.2020.02.005

Cited by 9 publications

(6 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…All ablation procedures including PVI were performed under the guidance of the 3D-electroanatomical mapping system (CARTO, Biosense Webster) with an LA geometry obtained from the CT image [ 13 ]. Intravenous heparin (100 IU/kg) was administered immediately after the puncture and was added properly to maintain an activated clotting time of 300–350 s during the procedure [ 14 , 15 ]. We used a 3.5 mm tip, open-irrigated contact force sensing ablation catheter (25–35 W, 42 °C, irrigation flow rate of 17–30 mL/min; Navistar ThermoCool SmartTouch, Biosense Webster, Inc.), a circular mapping catheter for PVI (Lasso, Biosense Webster, Inc., USA), and a multi-electrode mapping catheter for 3D-electroanatomical mapping (PentaRay, Biosense Webster, Inc., USA) [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

Regional left atrial conduction velocity in the anterior wall is associated with clinical recurrence of atrial fibrillation after catheter ablation: efficacy in combination with the ipsilateral low voltage area

Ohguchi

Inden²,

Fujita³

et al. 2022

BMC Cardiovasc Disord

Self Cite

View full text Add to dashboard Cite

Background Left atrial (LA) conduction velocity (CV) is an electrical remodeling parameter of atrial fibrillation (AF) substrate. However, the pathophysiological substrate of LA-CV and its impact on outcomes after catheter ablation for AF have not been well evaluated. Methods We retrospectively evaluated 119 patients with AF who underwent catheter ablation and electroanatomical mapping during sinus rhythm. To measure regional LA-CV, we took triplet sites (A, B, and C) on the activation map and calculated the magnitude of the matched orthogonal projection vector between vector-AB and vector-AC, indicating two-dimensional CV. The median of the LA-CVs from four triad sites in both the anterior and posterior walls was set as the ‘model LA-CV’. We evaluated the impact of the model LA-CV on recurrence after ablation and relationship between the model LA-CV and LA-low voltage area (LVA) of < 0.5 mV. Results During the 12-month follow-up, 29 patients experienced recurrence. The LA-CV model was significantly correlated with ipsilateral LVA. The lower anterior model LA-CV was significantly associated with recurrence, with the cut-off value of 0.80 m/s having a sensitivity of 72% and specificity of 67%. Multivariable analysis revealed that the anterior model LA-CV (hazard ratio, 0.09; 95% confidence interval, 0.01–0.94; p = 0.043) and anterior LA-LVA (hazard ratio, 1.06; 95% confidence interval, 1.00–1.11; p = 0.033) were independently associated with AF recurrence. The anterior LA-LVA was mildly correlated with the anterior model LA-CV (r = -0.358; p < 0.001), and patients with both lower LA-CV and greater anterior LA-LVA based on each cut-off value had the worst prognosis. However, decreased LA-CV was more likely to be affected by the distribution pattern of the LVA rather than the total size of the LVA. Conclusion Decreased anterior LA-CV was a significant predictor of AF recurrence and was a useful electrical parameter in addition to LA-LVA for estimating AF arrhythmogenicity.

show abstract

Section: Methodsmentioning

confidence: 99%

Regional left atrial conduction velocity in the anterior wall is associated with clinical recurrence of atrial fibrillation after catheter ablation: efficacy in combination with the ipsilateral low voltage area

Ohguchi

Inden²,

Fujita³

et al. 2022

BMC Cardiovasc Disord

Self Cite

View full text Add to dashboard Cite

show abstract

“…Cardiac tamponade, a major life-threatening complication, has been evaluated as a representative bleeding event in previous uninterrupted DOAC with CA studies. 21,22 In those studies, the frequency of cardiac tamponade under CA for AF with uninterrupted DOAC ranged from 0% (0/123) to 1.6% (1/64), with a mean of 0.66% (22/3,323). 21, 22 Currently, an incidence of cardiac tamponade of <1% seems to be acceptable during CA for AF.…”

Section: Discussionmentioning

confidence: 97%

Uninterrupted Direct Oral Anticoagulants Without a Change in Regimen for Catheter Ablation for Atrial Fibrillation Is an Acceptable Protocol

et al. 2021

View full text Add to dashboard Cite

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.

show abstract

“…Patients continued anticoagulant therapy for at least 3 weeks before the ablation procedure. Anticoagulant drugs including vitamin K antagonists and direct oral anticoagulants were uninterruptedly administered throughout the procedure [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

Comparison of the empirical linear ablation and low voltage area-guided ablation in addition to pulmonary vein isolation in patients with persistent atrial fibrillation: a propensity score-matched analysis

Suzuki

Kaneko

Fujita

et al. 2022

BMC Cardiovasc Disord

Self Cite

View full text Add to dashboard Cite

Background The efficacy of pulmonary vein isolation (PVI) alone is not guaranteed for persistent atrial fibrillation (PeAF), and it is unclear which type of ablation approach should be applied in addition to PVI. This study aimed to compare outcomes and prognosis between empirical linear ablation and low-voltage area (LVA) ablation after PVI for PeAF. Methods We enrolled 128 patients with PeAF who were assigned to the linear ablation group (n = 64) and the LVA ablation group (n = 64) using a propensity score-matched model. After PVI and cardioversion, the patients underwent either empirical linear ablation or LVA ablation during sinus rhythm. All patients in the linear ablation group underwent both roof line and mitral valve isthmus (MVI) ablations. An electrical-guided ablation targeting LVA (< 0.5 mV) was performed in the LVA group. When there was no LVA in the LVA group, only PVI was applied. We compared the procedural outcomes and recurrence after ablation between the two groups. Results The baseline characteristics were well-balanced between the two groups. Fifty patients had LVA (22 and 28 patients in the linear and LVA groups). The roof and MVI lines were completed in 100% and 96.9% of the patients. During the mean follow-up of 279.5 ± 161.3 days, the LVA group had significantly lower recurrence than the linear group (15 patients [23%] vs. 29 patients [45%], p = 0.014). Thirty-five patients were prescribed antiarrhythmic drugs during the follow-up period (linear group, n = 17; LVA group, n = 18); amiodarone and bepridil were administered to most of the patients (15 and 17 patients, respectively). The difference in the prognosis was relevant among the patients with LVA, while this trend was not observed in those without LVA. The LVA ablation group demonstrated significantly lower radiofrequency energy and shorter procedural time compared to the linear ablation group. The recurrence of atrial flutter was more likely to occur in the linear group than in the LVA group (14 [22%] vs. 6 [9.4%], p = 0.052). Conclusion The electrophysiological-guided LVA ablation is more effective than empirical linear ablation in PeAF patients with LVA. Unnecessary empirical linear ablation might have a risk of iatrogenic gap and atrial flutter recurrence.

show abstract

Periprocedural Management of Cardiac Tamponade During Catheter Ablation for AF Under Uninterrupted DOAC and Warfarin

Cited by 9 publications

References 14 publications

Regional left atrial conduction velocity in the anterior wall is associated with clinical recurrence of atrial fibrillation after catheter ablation: efficacy in combination with the ipsilateral low voltage area

Regional left atrial conduction velocity in the anterior wall is associated with clinical recurrence of atrial fibrillation after catheter ablation: efficacy in combination with the ipsilateral low voltage area

Uninterrupted Direct Oral Anticoagulants Without a Change in Regimen for Catheter Ablation for Atrial Fibrillation Is an Acceptable Protocol

Comparison of the empirical linear ablation and low voltage area-guided ablation in addition to pulmonary vein isolation in patients with persistent atrial fibrillation: a propensity score-matched analysis

Contact Info

Product

Resources

About