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COMPARISON OF OUTCOMES POST-CARDIOVERSION OF PATIENTS WITH DIFFERING PERI-PROCEDURAL ANTICOAGULATION REGIMENS
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Canadian Journal of Cardiology Volume 30 2014 CONCLUSION:
Advanced IAB is with a predictor of higher occurrence of AF after successful CTI ablation in patients with typical AFl and no prior history of AF. 248 COMPARISON OF OUTCOMES POST-CARDIOVERSION OF PATIENTS WITH DIFFERING PERI-PROCEDURAL ANTICOAGULATION REGIMENS A Verma, J Beardsall, R Juta, P Hache, T Lenton-Brym, B Tsang, A Pantano, Z Wulffhart, Y Khaykin
Newmarket, Ontario BACKGROUND:
HSF 247 ADVANCED INTERATRIAL BLOCK PREDICTS ATRIAL FIBRILLATION POST CAVOTRICUSPID ISTHMUS ABLATION FOR TYPICAL ATRIAL FLUTTER W Barake, A Enriquez, J Caldwell, F Sadiq Ali, D Conde, DP Redfearn, K Michael, H Abdollah, C Simpson, A Bayés de Luna, A Baranchuk Kingston, Ontario BACKGROUND:
A significant proportion of patients develop atrial fibrillation (AF) following cavo-tricuspid isthmus (CTI) ablation for typical atrial flutter (AFl). The aim of this study was to assess whether the presence of advanced interatrial block (aIAB) was associated with a higher risk of AF after CTI ablation in patients with typical AFl and no prior history of AF. METHODS: Patients with typical AFl and no prior history of AF referred for CTI ablation were included in the study. Redoablations and patients without demonstration of bidirectional block were excluded. In all patients, a post-ablation ECG in sinus rhythm was evaluated for the presence of aIAB, defined as a p-wave duration 120 ms and biphasic morphology in the inferior leads. New-onset AF was identified from 12-lead ECGs, Holter monitoring and device interrogations. RESULTS: The cohort consisted of 122 patients with mean age of 67 10.6 years, left atrial (LA) diameter 42.8 6 mm, ejection fraction 55.8 11.2% and 79.5% were male. Advanced IAB was detected in 23% of the patients. Over a mean follow-up was 30.5 15.3 months (median 30 months), 57 patients developed newonset AF (46.7%). The incidence of AF was greater in patients with aIAB (71.4%) compared to those without aIAB (39.4%, p¼0.003). After multivariate analysis, aIAB remained statistically significant (OR 2.9, 95% CI 1.02-8.6; p<0.04).
There is little data comparing traditional vitamin K antagonist (VKA) versus novel oral anticoagulant (NOAC) anticoagulation regimens peri-cardioversion. We sought to compare outcomes between VKA and NOAC anticoagulation around the time of elective cardioversion. METHODS: We studied consecutive patients undergoing cardioversion for atrial fibrillation at our center from October 2010 until October 2013. Patients were divided into three anticoagulation groups: VKA, dabigatran (DABI), and rivaroxaban (RIVA). All patients required a minimum of 3 weeks of therapeutic anticoagulation prior to cardioversion and a minimum of 4 weeks afterwards. Anticoagulation was maintained longer than 4 weeks according to CHADS2 risk score. For patients on VKA, therapeutic anticoagulation was confirmed by weekly INRs between 2 and 3 and for the NOACs, compliance was assessed by patient attestation. For patients with less than 4 weeks anticoagulation prior to cardioversion, trans-esophageal echo (TEE) was performed to rule out left atrial thrombus. In the absence of thrombus, cardioversion was performed. Bleeding was considered major if requiring hospitalization, transfusion, or cessation of anticoagulation for >7 days. Follow-up was complete for all patients (mean 128 months). RESULTS: A total of 901 patients undergoing cardioversion were studied: VKA n¼471, DABI n¼288, RIVA n¼141. Baseline characteristics of each group are detailed in the table. Mean INR for the VKA group was 2.70.7 on the day of cardioversion. In the DABI group, 79% were on the 150 mg BID dose (21% on 110 mg BID) and in the RIVA group, 90% were on the 20 mg QD dose (10% were on 15 mg QD). Stroke and bleeding outcomes are described in the table. CONCLUSION: There is a low incidence of peri-cardioversion adverse events for all three anticoagulation regimens. No strokes were seen in follow-up with only 2 TIAs in the DABI arm and bleeding was similar for all three arms.
Canadian Journal of Cardiology Volume 30 2014 CONCLUSION:
Advanced IAB is with a predictor of higher occurrence of AF after successful CTI ablation in patients with typical AFl and no prior history of AF. 248 COMPARISON OF OUTCOMES POST-CARDIOVERSION OF PATIENTS WITH DIFFERING PERI-PROCEDURAL ANTICOAGULATION REGIMENS A Verma, J Beardsall, R Juta, P Hache, T Lenton-Brym, B Tsang, A Pantano, Z Wulffhart, Y Khaykin
Newmarket, Ontario BACKGROUND:
HSF 247 ADVANCED INTERATRIAL BLOCK PREDICTS ATRIAL FIBRILLATION POST CAVOTRICUSPID ISTHMUS ABLATION FOR TYPICAL ATRIAL FLUTTER W Barake, A Enriquez, J Caldwell, F Sadiq Ali, D Conde, DP Redfearn, K Michael, H Abdollah, C Simpson, A Bayés de Luna, A Baranchuk Kingston, Ontario BACKGROUND:
A significant proportion of patients develop atrial fibrillation (AF) following cavo-tricuspid isthmus (CTI) ablation for typical atrial flutter (AFl). The aim of this study was to assess whether the presence of advanced interatrial block (aIAB) was associated with a higher risk of AF after CTI ablation in patients with typical AFl and no prior history of AF. METHODS: Patients with typical AFl and no prior history of AF referred for CTI ablation were included in the study. Redoablations and patients without demonstration of bidirectional block were excluded. In all patients, a post-ablation ECG in sinus rhythm was evaluated for the presence of aIAB, defined as a p-wave duration 120 ms and biphasic morphology in the inferior leads. New-onset AF was identified from 12-lead ECGs, Holter monitoring and device interrogations. RESULTS: The cohort consisted of 122 patients with mean age of 67 10.6 years, left atrial (LA) diameter 42.8 6 mm, ejection fraction 55.8 11.2% and 79.5% were male. Advanced IAB was detected in 23% of the patients. Over a mean follow-up was 30.5 15.3 months (median 30 months), 57 patients developed newonset AF (46.7%). The incidence of AF was greater in patients with aIAB (71.4%) compared to those without aIAB (39.4%, p¼0.003). After multivariate analysis, aIAB remained statistically significant (OR 2.9, 95% CI 1.02-8.6; p<0.04).
There is little data comparing traditional vitamin K antagonist (VKA) versus novel oral anticoagulant (NOAC) anticoagulation regimens peri-cardioversion. We sought to compare outcomes between VKA and NOAC anticoagulation around the time of elective cardioversion. METHODS: We studied consecutive patients undergoing cardioversion for atrial fibrillation at our center from October 2010 until October 2013. Patients were divided into three anticoagulation groups: VKA, dabigatran (DABI), and rivaroxaban (RIVA). All patients required a minimum of 3 weeks of therapeutic anticoagulation prior to cardioversion and a minimum of 4 weeks afterwards. Anticoagulation was maintained longer than 4 weeks according to CHADS2 risk score. For patients on VKA, therapeutic anticoagulation was confirmed by weekly INRs between 2 and 3 and for the NOACs, compliance was assessed by patient attestation. For patients with less than 4 weeks anticoagulation prior to cardioversion, trans-esophageal echo (TEE) was performed to rule out left atrial thrombus. In the absence of thrombus, cardioversion was performed. Bleeding was considered major if requiring hospitalization, transfusion, or cessation of anticoagulation for >7 days. Follow-up was complete for all patients (mean 128 months). RESULTS: A total of 901 patients undergoing cardioversion were studied: VKA n¼471, DABI n¼288, RIVA n¼141. Baseline characteristics of each group are detailed in the table. Mean INR for the VKA group was 2.70.7 on the day of cardioversion. In the DABI group, 79% were on the 150 mg BID dose (21% on 110 mg BID) and in the RIVA group, 90% were on the 20 mg QD dose (10% were on 15 mg QD). Stroke and bleeding outcomes are described in the table. CONCLUSION: There is a low incidence of peri-cardioversion adverse events for all three anticoagulation regimens. No strokes were seen in follow-up with only 2 TIAs in the DABI arm and bleeding was similar for all three arms.