| 고경정, 이현수¹ , 성주용¹ , 임라승¹ , 김진란¹ , 박재석¹ , 반지은¹ , 최종일¹ , 곽재진² , 박상원¹ , 김영훈¹ |
Background. Optimal anticoagulation (AC) before and after atrial fibrillation (AF) ablation is important to prevent thromboembolism while avoiding bleeding complications. The periprocedural AC strategy for safe radiofrequency catheter ablation (RFCA) remains to be clarified. We investigated the efficacy and safety of RFCA for AF in patients who continued to taking warfarin compared to those without pre-RFCA warfarin.
Methods and Results. 235 patients (M: F=179: 56, 55.7±11.1 years old, Paroxysmal AF: Pesistent AF=134: 101) undergoing RFCA for AF were included. We divided patients into group I (warfarin taking, n=140) and group II (antiplatelet only, n=95), and group I into those with INR<2 (n=103) and with INR>2 (n=37). The heparin dose to maintain activated clotting time (ACT) between 350 s and 400 s, maximum ACT, and periprocedural complications were compared. Minor bleeding was defined as hematoma that did not require intervention. Major bleeding was defined as either cardiac tamponade, hematoma that required intervention, or bleeding that required blood transfusion.
Results 1. Preprocedural INR (1.6±0.6 vs. 1.0±0.1, P<0.001) and maximum ACT during procedure (452±89s vs. 404±49s, P<0.001) in group I were higher than those in group II. Initial heparin bolus dose (IU/kg) (123.2±28.9 vs. 140.5±30.5, p<0.001) and total heparin dose per procedure time (IU/min) (61.2±29.8 vs. 85.1±25.4, P<0.001) were smaller. 2. There were no differences in the incidence of minor bleeding (10.0% in group I vs. 10.5% in group II, P=NS) and major bleeding (6.4% in group I vs. 9.5% in group II, P=NS) between two groups. 3. In the INR>2 group, maximum ACT (533±117s vs. 424±52s, P<0.001) was higher, whereas initial heparin bolus dose (IU/kg) (131.3±26.2 vs. 100.8±23.9, p<0.001) and total heparin dose per procedure time (IU/min) (40.5±20.2 vs. 68.6±29.2, p<0.001) were smaller. 4. Major bleeding (2.7% vs. 7.8%) occurred less common in INR >2 Group without significance.
Conclusion. Continuation of warfarin prior to RFCA for AF required less doses of heparin to maintain ACT between 350 s and 400 s and did not result in significant bleeding complications during and after RFCA for AF.
|
