Author + information
- Received October 11, 2019
- Revision received February 4, 2020
- Accepted February 6, 2020
- Published online March 25, 2020.
- Satoshi Yanagisawa, MD, PhDa,∗ (, )
- Yasuya Inden, MD, PhDb,
- Shiou Ohguchi, MDc,
- Tomoyuki Nagao, MD, PhDd,
- Aya Fujii, MDb,
- Toshiro Tomomatsu, MDb,
- Keita Mamiya, MDb,
- Hiroya Okamoto, MDb,
- Yusuke Sakamoto, MDb,
- Rei Shibata, MD, PhDa and
- Toyoaki Murohara, MD, PhDb
- aDepartment of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan
- bDepartment of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- cDepartment of Cardiology, Kasugai Municipal Hospital, Kasugai, Japan
- dDepartment of Cardiology, Chubu Rosai Hospital, Nagoya, Japan
- ↵∗Address for correspondence:
Dr. Satoshi Yanagisawa, Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
Objectives This was a retrospective analysis of a registry of patients who underwent catheter ablation for atrial fibrillation (AF) under uninterrupted direct oral anticoagulant (DOAC) and warfarin administration.
Background Uninterrupted DOAC used during catheter ablation for AF causes a life-threatening bleeding risk of cardiac tamponade.
Methods Of 3,149 catheter ablation procedures for AF with uninterrupted oral anticoagulants used in 2,406 patients in 3 institutions, DOAC and warfarin were administered in 1,896 and 1,253 procedures, respectively. Among them, cardiac tamponade requiring pericardiocentesis and surgical intervention occurred in 13 (0.7%) and 11 (0.9%) procedures in the DOAC and warfarin groups, respectively. In this study, the outcomes between these 2 groups were compared.
Results The total blood volumes drained after pericardiocentesis was 300 (190 to 715) ml and 300 (200 to 380) ml in the DOAC and warfarin groups, respectively (p = 0.697). Approximately two-thirds of patients (9 in the DOAC group and 7 in the warfarin group) recovered with only pericardiocentesis and protamine infusion (including vitamin K in the warfarin group) in both groups. Two patients in the DOAC group underwent surgical intervention but recovered uneventfully, whereas none of the patients taking warfarin required surgical intervention. DOAC and warfarin were successfully resumed 2.0 (2.0 to 5.0) days and 4.0 (2.0 to 5.5) days after tamponade in all patients without an increase in effusion (p = 0.102).
Conclusions Managing cardiac tamponade under uninterrupted DOAC administration was feasible. Early intensive treatment resulted in hemostasis in most patients. However, surgical intervention was required in some cases refractory to the initial treatment.
Drs. Yanagisawa and Shibata are affiliated with a department sponsored by Medtronic Japan. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received October 11, 2019.
- Revision received February 4, 2020.
- Accepted February 6, 2020.
- 2020 American College of Cardiology Foundation
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