Report of periprocedural oral anticoagulants in catheter ablation for atrial fibrillation: The Japanese Catheter Ablation Registry of Atrial Fibrillation (J‐CARAF)

Abstract

BackgroundTo obtain a perspective of the current status of catheter ablation for the cure of atrial fibrillation, the Japanese Heart Rhythm Society conducted a nationwide survey: the Japanese Catheter Ablation Registry of Atrial Fibrillation. In this report, we aimed to evaluate the periprocedural use of direct oral anticoagulants with respect to thromboembolic or bleeding complications.MethodsUsing an online questionnaire, the Japanese Heart Rhythm Society requested electrophysiology centers in Japan to register the relevant data of patients who underwent atrial fibrillation ablation over selected five-months from 2011 to 2014. We compared the clinical profiles and the ablation data, including the incidence of pericardial effusion, major bleeding, and ischemic stroke among patients with periprocedural use of warfarin or a direct oral anticoagulant.ResultsA total of 204 institutions reported data on 6200 atrial fibrillation ablation sessions. We analyzed data obtained from 4698 subjects (Age 63.2±10.6 yr; 73.9% male, 26.1% female) who were administered warfarin or a direct oral anticoagulant, at least up to the day before atrial fibrillation ablation. Warfarin was administered to 54.7% of patients. Dabigatran, rivaroxaban, and apixaban were used in 21.9%, 12.9%, and 10.6% of patients, respectively. Clinical profiles of apixaban-treated patients were similar to those of warfarin-treated patients; they were different from the clinical profiles of patients treated with dabigatran or rivaroxaban. There were 104 complications in 103 subjects (2.2%). Complications were more frequent in older patients (65.3±8.6 yr vs. 63.1±10.7 yr; P=0.012), patients on chronic hemodialysis (4.9% vs. 1.1%; P=0.001), or those treated with warfarin (66.0% vs. 54.4%; P=0.019). Multiple logistic regression analysis revealed that age (OR, 1.02; 95% CI: 1.00–1.04; P=0.035), chronic hemodialysis (OR, 4.40; CI: 1.68–11.50; P=0.003), and assistance by 3-D mapping system (OR, 0.30; CI: 0.16–0.57; P<0.001) were significantly related to the incidence of complications, while periprocedural direct oral anticoagulant was not a predictive factor for complication.ConclusionsCompared with uninterrupted warfarin, the choice of a direct oral anticoagulant as a periprocedural oral anticoagulant did not significantly change the incidence of serious complications.

Incidence and predictors of pericardial effusion as an early complication of catheter ablation for atrial fibrillation: The Japanese Catheter Ablation Registry of Atrial Fibrillation (J‐CARAF)

“…In earlier studies, uninterrupted warfarin was superior to an interrupted oral anticoagulant strategy for the outcome of AF ablation [10][11][12]. DOACs have been shown to be comparatively useful as warfarin as a periprocedural oral anticoagulant [4,[13][14][15][16]. In the present survey, the rate of warfarin use increased in the sequential order from PE[-] to critical PE, noncritical PE being intermediate, while the rate of DOAC use decreased in the same order.…”

“…To achieve efficacious and safe treatment of various arrhythmias, technological and technical innovations of catheter ablation are constantly being introduced into practice. To assess whether catheter ablation for the cure of atrial fibrillation (AF) is appropriately Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/joa performed in Japan, the Japanese Heart Rhythm Society (JHRS) started the annual nationwide registry of patients who underwent catheter ablation for AF: the Japanese Catheter Ablation Registry of Atrial Fibrillation (J-CARAF) [1][2][3][4].…”

Characteristics and anticoagulant treatment status of elderly non-valvular atrial fibrillation patients with a history of catheter ablation in Japan: Subanalysis of the ANAFIE registry

“…The present results are consistent with the findings of a recent nationwide survey of CA for AF conducted in Japan (J-CARAF) by the Japanese Heart Rhythm Society [34]. In J-CARAF, 4698 patients were administered warfarin or a DOAC up to the day before AF ablation, and 64.2% of patients had paroxysmal AF [34]. These findings are also in accordance with the current AF management guideline [10] and previous reports [9,[11][12][13][14][15].…”

“…The present results showed that there were significantly more patients with paroxysmal AF in the CA group than in the No-CA group (72.9% vs 38.9%), comprising almost two-fold the number of patients with paroxysmal AF in the No-CA group. The present results are consistent with the findings of a recent nationwide survey of CA for AF conducted in Japan (J-CARAF) by the Japanese Heart Rhythm Society [34]. In J-CARAF, 4698 patients were administered warfarin or a DOAC up to the day before AF ablation, and 64.2% of patients had paroxysmal AF [34].…”

Uninterrupted dabigatran is safer than warfarin in patients undergoing ablation for atrial fibrillation

“…We read with great interest the article by Murakawa et al [1] titled, “ Report of periprocedural oral anticoagulants in catheter ablation for atrial fibrillation: The Japanese Catheter Ablation Registry of Atrial Fibrillation (J-CARAF). ” The authors concluded that the choice of a novel oral anticoagulant (NOAC) as a periprocedural anticoagulant did not significantly alter the incidence of serious complications, compared with uninterrupted warfarin.…”