Clinical impact of heparin kinetics during catheter ablation of atrial fibrillation: Meta-analysis and meta-regression

David F. Briceno, Pedro A. Villablanca, Florentino Lupercio, Faraj Kargoli, Anand Jagannath, Alejandra Londono, Jignesh Patel, Olufisayo Otusanya, Jeannine Brevik, Carola Maraboto, Cecilia Berardi, Andrew Krumerman, Eugen Palma, Soo G. Kim, Andrea Natale, Luigi Di Biase

Research output: Contribution to journalArticlepeer-review

48 Scopus citations


Anticoagulation for Ablation of Atrial Fibrillation Introduction Appropriate activated clotting time (ACT) during catheter ablation of atrial fibrillation (CA-AF) is essential to minimize periprocedural complications. Methods and Results An electronic search was performed using major databases. Outcomes were thromboembolic (TE) and bleeding complications according to ACT levels (seconds). Heparin dose (U/kg) and time (minutes) to achieve the target ACT was compared among patients receiving vitamin K antagonist (VKA) versus non-VKA oral anticoagulants (NOAC). Nineteen studies involving 7,150 patients were identified. Patients with ACT > 300 had less TE (OR, 0.51; 95% CI 0.35-0.74) and bleeding (OR, 0.70; 95% CI 0.60-0.83) compared to ACT < 300, when using any type of oral anticoagulation. The use of VKA was associated with reduced heparin requirements (mean dose: 157 U/kg vs. 209 U/kg, P < 0.03; SDM -0.86 [95% CI -1.39 to -0.33]), and with lower time to achieve the target ACT (mean time: 24 minutes vs. 49 minutes, P < 0.03; SDM -11.02 [95% CI -13.29 to -8.75]) compared to NOACs. No significant publication bias was found. Conclusions Performing CA-AF with a target ACT > 300 decreases the risk of TE without increasing the risk of bleeding. Patients receiving VKAs required less heparin and reached the target ACT faster compared to NOACs.

Original languageEnglish (US)
Pages (from-to)683-693
Number of pages11
JournalJournal of cardiovascular electrophysiology
Issue number6
StatePublished - Jun 1 2016


  • NOAC
  • atrial fibrillation
  • bleeding
  • catheter ablation
  • heparin
  • meta-analysis
  • stroke
  • vitamin K antagonist

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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