However as the above results included patients who underwent
However, as the above results included patients who underwent RMN ablation during its introduction to our center when physicians were still in the process of familiarization, we proceeded to compare fluoroscopy and procedural times in the most recent 50 patients undergoing ablation in each cohort. This was to eliminate the learning curve effect where physicians had yet been able to garner full gaba receptor reduction benefits during their initial experience with RMN. This yielded an even greater magnitude of fluoroscopy time reduction in the RMN group vs MAN group (35.4±13.9 vs 61.2±32.6min, respectively; p<0.001).
A summary of the ablation outcomes among the two cohorts is shown in Table 2. Both acute procedural success rates (RMN vs MAN: 98.6% vs 95.6%, respectively; p=0.065) and complication rates (2.3% vs 4.8%, respectively; p=0.16) were comparable (Table 3).
Conflict of interest
Introduction Technological and technical innovations of catheter ablation for various arrhythmias are continuously being introduced into practice. Tenacious effort is required to ensure that in each country this treatment is performed in accordance with the international standards . The Japanese Heart Rhythm Society (JHRS) conducted annual nationwide registries of patients who underwent catheter ablation for atrial fibrillation (AF): the Japanese Catheter Ablation Registry of Atrial Fibrillation (J-CARAF) [2–4]. Currently, uninterrupted warfarin therapy is considered superior to interrupted anticoagulation strategy with respect to thromboembolic and bleeding complications [5–8]. Moreover, some studies, including our previous report , have evaluated the safety and efficacy of direct oral anticoagulants (DOAC) in the management of AF ablation [9–18]. However, the number of subjects analyzed in earlier studies is rather small. In this report, we compared the clinical features and incidence of bleeding complication and ischemic stroke during, and immediately after AF ablation among patients receiving periprocedural treatment with warfarin or a DOAC. The aim of this study was to elucidate the current status of the use of DOAC as a periprocedural anticoagulant during AF ablation in Japan, and to evaluate the periprocedural use of a DOAC with respect to thromboembolic or bleeding complications.
Material and methods The method of this survey has previously been reported [3,4]. In short, the survey was performed retrospectively using an online questionnaire. The JHRS members were notified by e-mail. Data on patient backgrounds, methods of pulmonary vein isolation and related techniques, complications, as well as the periprocedural pharmacological treatments were collected for AF ablation sessions performed in September 2011, May 2012, September 2012, September 2013, and September 2014. Patient data included age, sex, previous AF ablation, AF type (paroxysmal, PAF; persistent, or long-standing, LS; persistent), thromboembolism risk factors, and echocardiographic parameters. When one of the oral anticoagulants (OACs) was intentionally continued at least up to the day before the AF ablation, they were considered to have been used periprocedural. The OAC administered on the day of AF ablation was not included in the data. The continuous variables with a normal distribution were expressed as the mean±SD. Comparison of continuous variables between two groups was done using unpaired Student׳s t-test. Comparisons of variables among the four study groups were performed using one-way analysis of variance with post-hoc Bonferroni test. Categorical variables were compared using Tukey׳s test. A multiple logistic regression analysis was performed for variables with univariate P value<0.1, to detect the independent determinants for the occurrence of complications. A P<0.05 was considered statistically significant.
Conflict of interest