Feasibility and safety of percutaneous epicardial access for mapping and ablation for ventricular arrhythmias in patients on oral anticoagulants

Koji Miyamoto, Ammar M. Killu, Danesh K. Kella, David O. Hodge, Suraj Kapa, Siva Mulpuru, Abhishek J. Deshmukh, Douglas L Packer, Samuel J Asirvatham, Thomas M. Munger, Paul Andrew Friedman

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Abstract

Purpose: This study aimed to assess the risk of procedure-related complications of percutaneous epicardial access (EpiAcc) for radiofrequency catheter ablation (RFA) of ventricular arrhythmias (VAs) in patients chronically treated oral anticoagulants (OACs) with warfarin compared to those not on OACs. Methods: We analyzed 205 patients (53 ± 16 years, 155 males) undergoing percutaneous EpiAcc as part of an RFA for VAs, and compared the outcome between patients chronically on OACs with warfarin (OAC group) and those without (non-OAC group). Results: Forty-seven patients (23%) were chronically treated on OACs before their procedure. EpiAcc in patients on OAC (OAC group) was not associated with an increased risk of cardiac tamponade (11% vs. 6%, p = 0.238) compared to non-OAC group, but a higher risk of need for blood transfusion (17% vs. 6%; p = 0.013). With respect to the OAC group, the international normalized ratio (INR) on the day of the RFA was ≥ 2.0 in 9 patients (19%) and < 2.0 in the remaining 38 patients (81%). The rate of all complication and blood transfusion were similar between them (11% vs. 21%; p = 0.496, 11% vs. 18%; p = 0.600). Conclusion: Percutaneous EpiAcc in patients on chronic OAC with warfarin did not significantly increase the risk of cardiac tamponade, but was associated with a higher risk of need for blood transfusion. EpiACC in patients with an INR > 2.0 is reasonable in experienced hands when clinical indications are strong.

Original languageEnglish (US)
JournalJournal of Interventional Cardiac Electrophysiology
DOIs
StateAccepted/In press - Jan 1 2018

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Epicardial Mapping
Anticoagulants
Cardiac Arrhythmias
Safety
Catheter Ablation
Warfarin
Cardiac Tamponade
International Normalized Ratio
Blood Transfusion

Keywords

  • Complications
  • Epicardial access
  • Oral anticoagulants
  • Radiofrequency catheter ablation
  • Ventricular arrhythmias

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

@article{cea5bedac87f4e638a0ce928b6865b5e,
title = "Feasibility and safety of percutaneous epicardial access for mapping and ablation for ventricular arrhythmias in patients on oral anticoagulants",
abstract = "Purpose: This study aimed to assess the risk of procedure-related complications of percutaneous epicardial access (EpiAcc) for radiofrequency catheter ablation (RFA) of ventricular arrhythmias (VAs) in patients chronically treated oral anticoagulants (OACs) with warfarin compared to those not on OACs. Methods: We analyzed 205 patients (53 ± 16 years, 155 males) undergoing percutaneous EpiAcc as part of an RFA for VAs, and compared the outcome between patients chronically on OACs with warfarin (OAC group) and those without (non-OAC group). Results: Forty-seven patients (23{\%}) were chronically treated on OACs before their procedure. EpiAcc in patients on OAC (OAC group) was not associated with an increased risk of cardiac tamponade (11{\%} vs. 6{\%}, p = 0.238) compared to non-OAC group, but a higher risk of need for blood transfusion (17{\%} vs. 6{\%}; p = 0.013). With respect to the OAC group, the international normalized ratio (INR) on the day of the RFA was ≥ 2.0 in 9 patients (19{\%}) and < 2.0 in the remaining 38 patients (81{\%}). The rate of all complication and blood transfusion were similar between them (11{\%} vs. 21{\%}; p = 0.496, 11{\%} vs. 18{\%}; p = 0.600). Conclusion: Percutaneous EpiAcc in patients on chronic OAC with warfarin did not significantly increase the risk of cardiac tamponade, but was associated with a higher risk of need for blood transfusion. EpiACC in patients with an INR > 2.0 is reasonable in experienced hands when clinical indications are strong.",
keywords = "Complications, Epicardial access, Oral anticoagulants, Radiofrequency catheter ablation, Ventricular arrhythmias",
author = "Koji Miyamoto and Killu, {Ammar M.} and Kella, {Danesh K.} and Hodge, {David O.} and Suraj Kapa and Siva Mulpuru and Deshmukh, {Abhishek J.} and Packer, {Douglas L} and Asirvatham, {Samuel J} and Munger, {Thomas M.} and Friedman, {Paul Andrew}",
year = "2018",
month = "1",
day = "1",
doi = "10.1007/s10840-018-0441-0",
language = "English (US)",
journal = "Journal of Interventional Cardiac Electrophysiology",
issn = "1383-875X",
publisher = "Springer Netherlands",

}

TY - JOUR

T1 - Feasibility and safety of percutaneous epicardial access for mapping and ablation for ventricular arrhythmias in patients on oral anticoagulants

AU - Miyamoto, Koji

AU - Killu, Ammar M.

AU - Kella, Danesh K.

AU - Hodge, David O.

AU - Kapa, Suraj

AU - Mulpuru, Siva

AU - Deshmukh, Abhishek J.

AU - Packer, Douglas L

AU - Asirvatham, Samuel J

AU - Munger, Thomas M.

AU - Friedman, Paul Andrew

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Purpose: This study aimed to assess the risk of procedure-related complications of percutaneous epicardial access (EpiAcc) for radiofrequency catheter ablation (RFA) of ventricular arrhythmias (VAs) in patients chronically treated oral anticoagulants (OACs) with warfarin compared to those not on OACs. Methods: We analyzed 205 patients (53 ± 16 years, 155 males) undergoing percutaneous EpiAcc as part of an RFA for VAs, and compared the outcome between patients chronically on OACs with warfarin (OAC group) and those without (non-OAC group). Results: Forty-seven patients (23%) were chronically treated on OACs before their procedure. EpiAcc in patients on OAC (OAC group) was not associated with an increased risk of cardiac tamponade (11% vs. 6%, p = 0.238) compared to non-OAC group, but a higher risk of need for blood transfusion (17% vs. 6%; p = 0.013). With respect to the OAC group, the international normalized ratio (INR) on the day of the RFA was ≥ 2.0 in 9 patients (19%) and < 2.0 in the remaining 38 patients (81%). The rate of all complication and blood transfusion were similar between them (11% vs. 21%; p = 0.496, 11% vs. 18%; p = 0.600). Conclusion: Percutaneous EpiAcc in patients on chronic OAC with warfarin did not significantly increase the risk of cardiac tamponade, but was associated with a higher risk of need for blood transfusion. EpiACC in patients with an INR > 2.0 is reasonable in experienced hands when clinical indications are strong.

AB - Purpose: This study aimed to assess the risk of procedure-related complications of percutaneous epicardial access (EpiAcc) for radiofrequency catheter ablation (RFA) of ventricular arrhythmias (VAs) in patients chronically treated oral anticoagulants (OACs) with warfarin compared to those not on OACs. Methods: We analyzed 205 patients (53 ± 16 years, 155 males) undergoing percutaneous EpiAcc as part of an RFA for VAs, and compared the outcome between patients chronically on OACs with warfarin (OAC group) and those without (non-OAC group). Results: Forty-seven patients (23%) were chronically treated on OACs before their procedure. EpiAcc in patients on OAC (OAC group) was not associated with an increased risk of cardiac tamponade (11% vs. 6%, p = 0.238) compared to non-OAC group, but a higher risk of need for blood transfusion (17% vs. 6%; p = 0.013). With respect to the OAC group, the international normalized ratio (INR) on the day of the RFA was ≥ 2.0 in 9 patients (19%) and < 2.0 in the remaining 38 patients (81%). The rate of all complication and blood transfusion were similar between them (11% vs. 21%; p = 0.496, 11% vs. 18%; p = 0.600). Conclusion: Percutaneous EpiAcc in patients on chronic OAC with warfarin did not significantly increase the risk of cardiac tamponade, but was associated with a higher risk of need for blood transfusion. EpiACC in patients with an INR > 2.0 is reasonable in experienced hands when clinical indications are strong.

KW - Complications

KW - Epicardial access

KW - Oral anticoagulants

KW - Radiofrequency catheter ablation

KW - Ventricular arrhythmias

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U2 - 10.1007/s10840-018-0441-0

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