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

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).