Regional differences in patient characteristics and outcomes during uninterrupted anticoagulation with dabigatran versus warfarin in catheter ablation of atrial fibrillation

the RE-CIRCUIT study

RE-CIRCUIT® investigators

Research output: Contribution to journalArticle

Abstract

Purpose: To describe regional differences in patient characteristics, ablation procedures, and bleeding events in the RE-CIRCUIT study. RE-CIRCUIT was a prospective, multicenter study that captured data from different regions, providing an opportunity to understand the practices followed in various regions. The incidence of major bleeding events (MBEs) was significantly lower with uninterrupted dabigatran versus uninterrupted warfarin. Methods: Patients were randomized to receive dabigatran 150 mg twice daily or warfarin. Ablation was performed with uninterrupted anticoagulation for 8 weeks after the procedure. Regions were Western Europe, Eastern Europe, North America, and Asia. Results: Of 704 patients screened across 104 sites, 635 underwent catheter ablation (dabigatran, 317; warfarin, 318). Patient characteristics were different across various regions. Patients from North America had the highest prevalence of atrial flutter (33%), coronary artery disease (29%), diabetes mellitus (18%), and previous myocardial infarction (9%). Hypertension was most prevalent in Eastern Europe (75%), as was congestive heart failure (40% vs 2% in Western Europe). Pulmonary vein isolation alone was the preferred technique used in most patients (86% in North America and 75–83% elsewhere) and radio frequency was the preferred energy source. The major outcome measure, incidence of MBEs during and up to 2 months after the procedure, was consistently lower with uninterrupted dabigatran versus warfarin, irrespective of regions and their procedural differences, and different ablation techniques utilized. Conclusions: This analysis shows that the benefits of dabigatran over a vitamin K antagonist in patients undergoing atrial fibrillation ablation are consistent across all geographic regions studied. Trial registration: NCT02348723 (https://clinicaltrials.gov/ct2/show/NCT02348723).

Original languageEnglish (US)
JournalJournal of Interventional Cardiac Electrophysiology
DOIs
StatePublished - Jan 1 2019

Fingerprint

Catheter Ablation
Warfarin
Atrial Fibrillation
North America
Eastern Europe
Hemorrhage
Northern Asia
Ablation Techniques
Atrial Flutter
Vitamin K
Pulmonary Veins
Incidence
Dabigatran
Radio
Multicenter Studies
Coronary Artery Disease
Diabetes Mellitus
Heart Failure
Myocardial Infarction
Outcome Assessment (Health Care)

Keywords

  • Ablation
  • Anticoagulation
  • Atrial fibrillation
  • Dabigatran
  • Regional difference
  • Warfarin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

@article{6848c531d9894b51bf5be31b837e4878,
title = "Regional differences in patient characteristics and outcomes during uninterrupted anticoagulation with dabigatran versus warfarin in catheter ablation of atrial fibrillation: the RE-CIRCUIT study",
abstract = "Purpose: To describe regional differences in patient characteristics, ablation procedures, and bleeding events in the RE-CIRCUIT study. RE-CIRCUIT was a prospective, multicenter study that captured data from different regions, providing an opportunity to understand the practices followed in various regions. The incidence of major bleeding events (MBEs) was significantly lower with uninterrupted dabigatran versus uninterrupted warfarin. Methods: Patients were randomized to receive dabigatran 150 mg twice daily or warfarin. Ablation was performed with uninterrupted anticoagulation for 8 weeks after the procedure. Regions were Western Europe, Eastern Europe, North America, and Asia. Results: Of 704 patients screened across 104 sites, 635 underwent catheter ablation (dabigatran, 317; warfarin, 318). Patient characteristics were different across various regions. Patients from North America had the highest prevalence of atrial flutter (33{\%}), coronary artery disease (29{\%}), diabetes mellitus (18{\%}), and previous myocardial infarction (9{\%}). Hypertension was most prevalent in Eastern Europe (75{\%}), as was congestive heart failure (40{\%} vs 2{\%} in Western Europe). Pulmonary vein isolation alone was the preferred technique used in most patients (86{\%} in North America and 75–83{\%} elsewhere) and radio frequency was the preferred energy source. The major outcome measure, incidence of MBEs during and up to 2 months after the procedure, was consistently lower with uninterrupted dabigatran versus warfarin, irrespective of regions and their procedural differences, and different ablation techniques utilized. Conclusions: This analysis shows that the benefits of dabigatran over a vitamin K antagonist in patients undergoing atrial fibrillation ablation are consistent across all geographic regions studied. Trial registration: NCT02348723 (https://clinicaltrials.gov/ct2/show/NCT02348723).",
keywords = "Ablation, Anticoagulation, Atrial fibrillation, Dabigatran, Regional difference, Warfarin",
author = "{RE-CIRCUIT{\circledR} investigators} and Hohnloser, {Stefan H.} and Hugh Calkins and Stephan Willems and Atul Verma and Richard Schilling and Ken Okumura and Matias Nordaby and Eva Kleine and Branislav Biss and Gerstenfeld, {Edward P.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s10840-019-00518-x",
language = "English (US)",
journal = "Journal of Interventional Cardiac Electrophysiology",
issn = "1383-875X",
publisher = "Springer Netherlands",

}

TY - JOUR

T1 - Regional differences in patient characteristics and outcomes during uninterrupted anticoagulation with dabigatran versus warfarin in catheter ablation of atrial fibrillation

T2 - the RE-CIRCUIT study

AU - RE-CIRCUIT® investigators

AU - Hohnloser, Stefan H.

AU - Calkins, Hugh

AU - Willems, Stephan

AU - Verma, Atul

AU - Schilling, Richard

AU - Okumura, Ken

AU - Nordaby, Matias

AU - Kleine, Eva

AU - Biss, Branislav

AU - Gerstenfeld, Edward P.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: To describe regional differences in patient characteristics, ablation procedures, and bleeding events in the RE-CIRCUIT study. RE-CIRCUIT was a prospective, multicenter study that captured data from different regions, providing an opportunity to understand the practices followed in various regions. The incidence of major bleeding events (MBEs) was significantly lower with uninterrupted dabigatran versus uninterrupted warfarin. Methods: Patients were randomized to receive dabigatran 150 mg twice daily or warfarin. Ablation was performed with uninterrupted anticoagulation for 8 weeks after the procedure. Regions were Western Europe, Eastern Europe, North America, and Asia. Results: Of 704 patients screened across 104 sites, 635 underwent catheter ablation (dabigatran, 317; warfarin, 318). Patient characteristics were different across various regions. Patients from North America had the highest prevalence of atrial flutter (33%), coronary artery disease (29%), diabetes mellitus (18%), and previous myocardial infarction (9%). Hypertension was most prevalent in Eastern Europe (75%), as was congestive heart failure (40% vs 2% in Western Europe). Pulmonary vein isolation alone was the preferred technique used in most patients (86% in North America and 75–83% elsewhere) and radio frequency was the preferred energy source. The major outcome measure, incidence of MBEs during and up to 2 months after the procedure, was consistently lower with uninterrupted dabigatran versus warfarin, irrespective of regions and their procedural differences, and different ablation techniques utilized. Conclusions: This analysis shows that the benefits of dabigatran over a vitamin K antagonist in patients undergoing atrial fibrillation ablation are consistent across all geographic regions studied. Trial registration: NCT02348723 (https://clinicaltrials.gov/ct2/show/NCT02348723).

AB - Purpose: To describe regional differences in patient characteristics, ablation procedures, and bleeding events in the RE-CIRCUIT study. RE-CIRCUIT was a prospective, multicenter study that captured data from different regions, providing an opportunity to understand the practices followed in various regions. The incidence of major bleeding events (MBEs) was significantly lower with uninterrupted dabigatran versus uninterrupted warfarin. Methods: Patients were randomized to receive dabigatran 150 mg twice daily or warfarin. Ablation was performed with uninterrupted anticoagulation for 8 weeks after the procedure. Regions were Western Europe, Eastern Europe, North America, and Asia. Results: Of 704 patients screened across 104 sites, 635 underwent catheter ablation (dabigatran, 317; warfarin, 318). Patient characteristics were different across various regions. Patients from North America had the highest prevalence of atrial flutter (33%), coronary artery disease (29%), diabetes mellitus (18%), and previous myocardial infarction (9%). Hypertension was most prevalent in Eastern Europe (75%), as was congestive heart failure (40% vs 2% in Western Europe). Pulmonary vein isolation alone was the preferred technique used in most patients (86% in North America and 75–83% elsewhere) and radio frequency was the preferred energy source. The major outcome measure, incidence of MBEs during and up to 2 months after the procedure, was consistently lower with uninterrupted dabigatran versus warfarin, irrespective of regions and their procedural differences, and different ablation techniques utilized. Conclusions: This analysis shows that the benefits of dabigatran over a vitamin K antagonist in patients undergoing atrial fibrillation ablation are consistent across all geographic regions studied. Trial registration: NCT02348723 (https://clinicaltrials.gov/ct2/show/NCT02348723).

KW - Ablation

KW - Anticoagulation

KW - Atrial fibrillation

KW - Dabigatran

KW - Regional difference

KW - Warfarin

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U2 - 10.1007/s10840-019-00518-x

DO - 10.1007/s10840-019-00518-x

M3 - Article

JO - Journal of Interventional Cardiac Electrophysiology

JF - Journal of Interventional Cardiac Electrophysiology

SN - 1383-875X

ER -