Department of Electrophysiology, St. Bartholomew's Hospital, West Smithfield, London, UK.
J Cardiovasc Electrophysiol. 2011 Mar;22(3):265-70. doi: 10.1111/j.1540-8167.2010.01910.x. Epub 2010 Oct 6.
Catheter ablation for atrial fibrillation is an effective treatment for symptomatic patients who have failed drug therapy. Recent studies using intracardiac echocardiography have demonstrated that ablation can be performed safely on uninterrupted warfarin and may be superior to bridging low molecular weight heparin (LMWH). We sought to assess the safety of an uninterrupted warfarin protocol using a simplified ablation protocol in a prospective controlled study.
Two anticoagulation regimes for patients undergoing catheter ablation for atrial fibrillation were evaluated--a bridging LMWH group and an uninterrupted warfarin group. Bleeding complications were compared between the 2 groups.
In total 198 patients were evaluated (109 bridging LMWH, 89 uninterrupted warfarin). The preprocedure INR in the LMWH group (mean age 60.6 years, 72% male) was 1.2 ± 0.3 compared to 2.3 ± 0.5 in the uninterrupted warfarin group (mean age 60.9 years, 69% male). The primary outcome (a composite of major and minor bleeding complications) was observed in 78% in the LMWH group compared to 56% in the warfarin group (P = 0.001), mainly due to increased pain at the venous access site (41% vs 16%, P = 0.001). Two patients undergoing ablation on warfarin required pericardiocentesis for cardiac tamponade. Drug costs were lower in the warfarin group ($64.77 ± 31.86 vs $20.76 ± 15.60, P = 0.005), but the overall cost of treatment per patient (including bed occupancy costs) was similar in the LMWH group compared to the warfarin group ($883.96 ± 278.78 vs $816.59 ± 182.72, P = 0.06).
Catheter ablation for atrial fibrillation can be performed safely on uninterrupted warfarin without intracardiac echocardiography, with a reduced risk of bleeding complications.
房颤导管消融术是一种有效的治疗方法，适用于药物治疗失败的有症状患者。最近使用心内超声的研究表明，在不停用华法林的情况下可以安全地进行消融术，并且可能优于桥接低分子肝素（LMWH）。我们旨在评估使用简化消融方案的不停用华法林方案的安全性，并进行前瞻性对照研究。
评估了两种用于房颤导管消融术的抗凝方案 - 桥接 LMWH 组和不停用华法林组。比较了两组之间的出血并发症。
共评估了 198 例患者（桥接 LMWH 组 109 例，不停用华法林组 89 例）。LMWH 组的术前 INR（平均年龄 60.6 岁，72%为男性）为 1.2 ± 0.3，而不停用华法林组为 2.3 ± 0.5（平均年龄 60.9 岁，69%为男性）。LMWH 组主要和次要出血并发症的主要结局发生率为 78%，而华法林组为 56%（P = 0.001），主要是由于静脉入路部位疼痛增加（41%比 16%，P = 0.001）。两名接受华法林消融的患者需要心包穿刺以治疗心脏压塞。华法林组的药物费用较低（$64.77 ± 31.86 比 $20.76 ± 15.60，P = 0.005），但每组患者的总治疗费用（包括床位占用成本）在 LMWH 组和华法林组之间相似（$883.96 ± 278.78 比 $816.59 ± 182.72，P = 0.06）。
房颤导管消融术可以在不停用华法林且无心内超声的情况下安全进行，出血并发症风险降低。
