Report of periprocedural oral anticoagulants in catheter ablation for atrial fibrillation: The Japanese Catheter Ablation Registry of Atrial Fibrillation (J-CARAF)

BACKGROUND: To obtain a perspective of the current status of catheter ablation for the cure of atrial fibrillation, the Japanese Heart Rhythm Society conducted a nationwide survey: the Japanese Catheter Ablation Registry of Atrial Fibrillation. In this report, we aimed to evaluate the periprocedural use of direct oral anticoagulants with respect to thromboembolic or bleeding complications. METHODS: Using an online questionnaire, the Japanese Heart Rhythm Society requested electrophysiology centers in Japan to register the relevant data of patients who underwent atrial fibrillation ablation over selected five-months from 2011 to 2014. We compared the clinical profiles and the ablation data, including the incidence of pericardial effusion, major bleeding, and ischemic stroke among patients with periprocedural use of warfarin or a direct oral anticoagulant. RESULTS: A total of 204 institutions reported data on 6200 atrial fibrillation ablation sessions. We analyzed data obtained from 4698 subjects (Age 63.2±10.6 yr; 73.9% male, 26.1% female) who were administered warfarin or a direct oral anticoagulant, at least up to the day before atrial fibrillation ablation. Warfarin was administered to 54.7% of patients. Dabigatran, rivaroxaban, and apixaban were used in 21.9%, 12.9%, and 10.6% of patients, respectively. Clinical profiles of apixaban-treated patients were similar to those of warfarin-treated patients; they were different from the clinical profiles of patients treated with dabigatran or rivaroxaban. There were 104 complications in 103 subjects (2.2%). Complications were more frequent in older patients (65.3±8.6 yr vs. 63.1±10.7 yr; P=0.012), patients on chronic hemodialysis (4.9% vs. 1.1%; P=0.001), or those treated with warfarin (66.0% vs. 54.4%; P=0.019). Multiple logistic regression analysis revealed that age (OR, 1.02; 95% CI: 1.00–1.04; P=0.035), chronic hemodialysis (OR, 4.40; CI: 1.68–11.50; P=0.003), and assistance by 3-D mapping system (OR, 0.30; CI: 0.16–0.57; P<0.001) were significantly related to the incidence of complications, while periprocedural direct oral anticoagulant was not a predictive factor for complication. CONCLUSIONS: Compared with uninterrupted warfarin, the choice of a direct oral anticoagulant as a periprocedural oral anticoagulant did not significantly change the incidence of serious complications.