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Open Access 01-06-2018 | Review Article

Periprocedural anticoagulation in atrial fibrillation: Update on electrical cardioversion and ablation

Authors: S. P. G. van Vugt, M. A. Brouwer

Published in: Netherlands Heart Journal | Issue 6/2018

Abstract

In this manuscript, we discuss the most important changes in the field of anticoagulant treatment in patients with atrial fibrillation in the setting of electrical cardioversion or catheter ablation. Moreover, we provide practical guidance as well as information on daily practice.

Crijns HJ, Weijs B, Fairley AM, et al. Contemporary real life cardioversion of atrial fibrillation: results from the multinational RHYTHM-AF study. Int J Cardiol. 2014;172(3):588–94.CrossRefPubMed

Bellone A, Etteri M, Vettorello M, et al. Cardioversion of acute atrial fibrillation in the emergency department: a prospective randomised trial. Emerg Med J. 2012;29(3):188–91.CrossRefPubMed

Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893–962.CrossRefPubMed

Letelier LM, Udol K, Ena J, et al. Effectiveness of amiodarone for conversion of atrial fibrillation to sinus rhythm: a meta-analysis. Arch Intern Med. 2003;163(7):777–85.CrossRefPubMed

Bash LD, Buono JL, Davies GM, et al. Systematic review and meta-analysis of the efficacy of cardioversion by vernakalant and comparators in patients with atrial fibrillation. Cardiovasc Drugs Ther. 2012;26(2):167–79.CrossRefPubMed

Airaksinen KJ. Cardioversion of atrial fibrillation and oral anticoagulation. J Atr Fibrillation. 2015;8(3):1260.PubMedPubMedCentral

Cappato R, Ezekowitz MD, Klein AL, et al. Rivaroxaban vs. vitamin K antagonists for cardioversion in atrial fibrillation. Eur Heart J. 2014;35(47):3346–55.CrossRefPubMed

Goette A, Merino JL, Ezekowitz MD, et al. Edoxaban versus enoxaparin-warfarin in patients undergoing cardioversion of atrial fibrillation (ENSURE-AF): a randomised, open-label, phase 3b trial. Lancet. 2016;388(10055):1995–2003.CrossRefPubMed

Ezekowitz MD, Pollack CV, Halperin JL, et al. Apixaban compared to heparin/vitamin K antagonist in patients with atrial fibrillation scheduled for cardioversion: the EMANATE trial. Eur Heart J 2018. Apr 6 (epub ahead of print).

10.

Camm AJ, Kirchhof P, Lip GY, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010;31(19):2369–429.CrossRefPubMed

11.

Nuotio I, Hartikainen JE, Gronberg T, et al. Time to cardioversion for acute atrial fibrillation and thromboembolic complications. JAMA. 2014;312(6):647–9.CrossRefPubMed

12.

Airaksinen KE, Gronberg T, Nuotio I, et al. Thromboembolic complications after cardioversion of acute atrial fibrillation: the FinCV (Finnish CardioVersion) study. J Am Coll Cardiol. 2013;62(13):1187–92.CrossRefPubMed

13.

Gronberg T, Hartikainen JE, Nuotio I, et al. Anticoagulation, CHA2DS2VAsc score, and thromboembolic risk of cardioversion of acute atrial fibrillation (from the FinCV study). Am J Cardiol. 2016;117(8):1294–8.CrossRefPubMed

14.

Hansen ML, Jepsen RM, Olesen JB, et al. Thromboembolic risk in 16 274 atrial fibrillation patients undergoing direct current cardioversion with and without oral anticoagulant therapy. Europace. 2015;17(1):18–23.CrossRefPubMed

15.

Fatkin D, Kuchar DL, Thorburn CW, et al. Transesophageal echocardiography before and during direct current cardioversion of atrial fibrillation: evidence for “atrial stunning” as a mechanism of thromboembolic complications. J Am Coll Cardiol. 1994;23(2):307–16.CrossRefPubMed

16.

Lip GY, Gitt AK, Le Heuzey JY, et al. Overtreatment and undertreatment with anticoagulation in relation to cardioversion of atrial fibrillation (the RHYTHM-AF study). Am J Cardiol. 2014;113(3):480–4.CrossRefPubMed

17.

Berger M, Schweitzer P. Timing of thromboembolic events after electrical cardioversion of atrial fibrillation or flutter: a retrospective analysis. Am J Cardiol. 1998;82(12):1545–7.CrossRefPubMed

18.

Gallagher MM, Hennessy BJ, Edvardsson N, et al. Embolic complications of direct current cardioversion of atrial arrhythmias: association with low intensity of anticoagulation at the time of cardioversion. J Am Coll Cardiol. 2002;40(5):926–33.CrossRefPubMed

19.

Khan IA. Atrial stunning: basics and clinical considerations. Int J Cardiol. 2003;92(2–3):113–28.CrossRefPubMed

20.

Stellbrink C, Nixdorff U, Hofmann T, et al. Safety and efficacy of enoxaparin compared with unfractionated heparin and oral anticoagulants for prevention of thromboembolic complications in cardioversion of nonvalvular atrial fibrillation: the Anticoagulation in Cardioversion using Enoxaparin (ACE) trial. Circulation. 2004;109(8):997–1003.CrossRefPubMed

21.

Cohen A, Stellbrink C, Le Heuzey JY, et al. SAfety of fondaparinux in transoesophageal echocardiography-guided electric cardioversion of Atrial Fibrillation (SAFE-AF) study: a pilot study. Arch Cardiovasc Dis. 2015;108(2):122–31.CrossRefPubMed

22.

Klein AL, Jasper SE, Katz WE, et al. The use of enoxaparin compared with unfractionated heparin for short-term antithrombotic therapy in atrial fibrillation patients undergoing transoesophageal echocardiography-guided cardioversion: assessment of Cardioversion Using Transoesophageal Echocardiography (ACUTE) II randomized multicentre study. Eur Heart J. 2006;27(23):2858–65.CrossRefPubMed

23.

Garcia DA, Baglin TP, Weitz JI, et al. Parenteral anticoagulants: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e24S–e43S.CrossRefPubMedPubMedCentral

24.

Nagarakanti R, Ezekowitz MD, Oldgren J, et al. Dabigatran versus warfarin in patients with atrial fibrillation: an analysis of patients undergoing cardioversion. Circulation. 2011;123(2):131–6.CrossRefPubMed

25.

Camm AJ, Lip GY, De Caterina R, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation—developed with the special contribution of the European Heart Rhythm Association. Europace. 2012;14(10):1385–413.CrossRefPubMed

26.

Piccini JP, Stevens SR, Lokhnygina Y, et al. Outcomes after cardioversion and atrial fibrillation ablation in patients treated with rivaroxaban and warfarin in the ROCKET AF trial. J Am Coll Cardiol. 2013;61(19):1998–2006.CrossRefPubMed

27.

Flaker G, Lopes RD, Al-Khatib SM, et al. Efficacy and safety of apixaban in patients after cardioversion for atrial fibrillation: insights from the ARISTOTLE Trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation). J Am Coll Cardiology. 2014;63(11):1082–7.CrossRef

28.

Plitt A, Ezekowitz MD, De Caterina R, et al. Cardioversion of Atrial Fibrillation in ENGAGE AF-TIMI 48. Clin Cardiol. 2016;39(6):345–6.CrossRefPubMed

29.

Kochhauser S, Khaykin Y, Beardsall J, et al. Comparison of outcomes after cardioversion or atrial fibrillation ablation in patients with differing periprocedural anticoagulation regimens. Can J Cardiol. 2014;30(12):1541–6.CrossRefPubMed

30.

Coleman CM, Khalaf S, Mould S, et al. Novel oral anticoagulants for DC cardioversion procedures: utilization and clinical outcomes compared with warfarin. Pacing Clin Electrophysiol. 2015;38(6):731–7.CrossRefPubMed

31.

Pallisgaard JL, Lindhardt TB, Hansen ML, et al. Cardioversion and risk of adverse events with dabigatran versus warfarin—a nationwide cohort study. PLoS ONE. 2015;10(10):e141377.CrossRefPubMedPubMedCentral

32.

Frederiksen AS, Albertsen AE, Christesen AMS, Vinter N, Frost L, Moller DS. Cardioversion of atrial fibrillation in a real-world setting: non-vitamin K antagonist oral anticoagulants ensure a fast and safe strategy compared to warfarin. Europace. 2017; https://doi.org/10.1093/europace/eux188.PubMedCrossRef

33.

Itainen S, Lehto M, Vasankari T, et al. Non-vitamin K antagonist oral anticoagulants in atrial fibrillation patients undergoing elective cardioversion. Europace. 2018;20(4):565.CrossRefPubMed

34.

Renda G, Ricci F, De Caterina R. Non-vitamin K antagonist oral anticoagulants for cardioversion in atrial fibrillation: an updated meta-analysis. Am J Med. 2017;130(4):457–61.CrossRefPubMed

35.

Raval AN, Cigarroa JE, Chung MK, et al. Management of patients on non-vitamin K antagonist oral anticoagulants in the acute care and periprocedural setting: a scientific statement from the American heart association. Circulation. 2017;135(10):e604–e33.CrossRefPubMedPubMedCentral

36.

Pisters R, Nieuwlaat R, Prins MH, et al. Clinical correlates of immediate success and outcome at 1‑year follow-up of real-world cardioversion of atrial fibrillation: the Euro Heart Survey. Europace. 2012;14(5):666–74.CrossRefPubMed

37.

Hernandez-Madrid A, Svendsen JH, Lip GY, et al. Cardioversion for atrial fibrillation in current European practice: results of the European Heart Rhythm Association survey. Europace. 2013;15(6):915–8.CrossRefPubMed

38.

Kuck KH, Brugada J, Furnkranz A, et al. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. N Engl J Med. 2016;374(23):2235–45.CrossRefPubMed

39.

Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace. 2018;20(1):e1–e160.CrossRefPubMed

40.

Di Biase L, Burkhardt JD, Santangeli P, et al. Periprocedural stroke and bleeding complications in patients undergoing catheter ablation of atrial fibrillation with different anticoagulation management: results from the Role of Coumadin in Preventing Thromboembolism in Atrial Fibrillation (AF) Patients Undergoing Catheter Ablation (COMPARE) randomized trial. Circulation. 2014;129(25):2638–44.CrossRefPubMed

41.

Cappato R, Marchlinski FE, Hohnloser SH, et al. Uninterrupted rivaroxaban vs. uninterrupted vitamin K antagonists for catheter ablation in non-valvular atrial fibrillation. Eur Heart J. 2015;36(28):1805–11.CrossRefPubMedPubMedCentral

42.

Calkins H, Willems S, Gerstenfeld EP, et al. Uninterrupted dabigatran versus warfarin for ablation in atrial fibrillation. N Engl J Med. 2017;376(17):1627–36.CrossRefPubMed

43.

Potpara TS, Larsen TB, Deharo JC, et al. Oral anticoagulant therapy for stroke prevention in patients with atrial fibrillation undergoing ablation: results from the First European Snapshot Survey on Procedural Routines for Atrial Fibrillation Ablation (ESS-PRAFA). Europace. 2015;17(6):986–93.CrossRefPubMed

44.

Cardoso R, Knijnik L, Bhonsale A, et al. An updated meta-analysis of novel oral anticoagulants versus vitamin K antagonists for uninterrupted anticoagulation in atrial fibrillation catheter ablation. Heart Rhythm. 2018;15(1):107–15.CrossRefPubMed

45.

Wu S, Yang YM, Zhu J, et al. Meta-analysis of efficacy and safety of new oral anticoagulants compared with uninterrupted vitamin K antagonists in patients undergoing catheter ablation for atrial fibrillation. Am J Cardiol. 2016;117(6):926–34.CrossRefPubMed

46.

Goya M, Nogami A, Hirao K, et al. Ablation perioperative dabigatran in use envisioning in Japan: the ABRIDGE-J study design. J Cardiol. 2016;68(3):236–40.CrossRefPubMed

47.

Di Biase L, Callans D, Haeusler KG, et al. Rationale and design of AXAFA-AFNET 5: an investigator-initiated, randomized, open, blinded outcome assessment, multi-centre trial to comparing continuous apixaban to vitamin K antagonists in patients undergoing atrial fibrillation catheter ablation. Europace. 2017;19(1):132–8.CrossRefPubMed

48.

Zhao Y, Yang Y, Tang X, et al. New oral anticoagulants compared to warfarin for perioperative anticoagulation in patients undergoing atrial fibrillation catheter ablation: a meta-analysis of continuous or interrupted new oral anticoagulants during ablation compared to interrupted or continuous warfarin. J Interv Card Electrophysiol. 2017;48(3):267–82.CrossRefPubMed

49.

Ezekowitz MD, Pollack CV, Sanders P, et al. Apixaban compared with parenteral heparin and/or vitamin K antagonist in patients with nonvalvular atrial fibrillation undergoing cardioversion: rationale and design of the EMANATE trial. Am Heart J. 2016;179:59–68.CrossRefPubMed

Title: Periprocedural anticoagulation in atrial fibrillation: Update on electrical cardioversion and ablation
Authors: S. P. G. van Vugt
M. A. Brouwer
Publication date: 01-06-2018
Publisher: Bohn Stafleu van Loghum
Published in: Netherlands Heart Journal / Issue 6/2018
Print ISSN: 1568-5888
Electronic ISSN: 1876-6250
DOI: https://doi.org/10.1007/s12471-018-1119-z

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