Catheter Ablation for Atrial Fibrillation on Uninterrupted Warfarin: Can It Be Done Without Echo Guidance?

Methods: 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. Results: 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). Conclusion: Catheter ablation for atrial fibrillation can be performed safely on uninterrupted warfarin without intracardiac echocardiography, with a reduced risk of bleeding complications. (J Cardiovasc Electrophysiol, Vol. 22, pp. 265-270, March 2011).