Background: RE-CIRCUIT was a prospective, randomized, open-label, blinded adjudicated-endpoint, multicenter study in patients scheduled for catheter ablation for paroxysmal or persistent atrial fibrillation (AF). The results showed that the incidence of major bleeding events (MBEs) was significantly lower in patients treated with uninterrupted dabigatran etexilate (DE) than those receiving uninterrupted warfarin. Here we describe regional differences in patient characteristics, ablation procedures and bleeding incidence.
Methods: Patients were randomly assigned to DE 150 mg twice daily or warfarin. Ablation was performed with uninterrupted anticoagulation, which was continued for 8 weeks after the procedure. Regions were grouped into North America (NA), Asia (A), Western Europe (WE) and Eastern Europe (EE).
Results: A total of 635 patients (mean ± SD age 59.2 ± 10.3 years; 75% male) underwent catheter ablation (DE, 317; warfarin, 318). Patients from NA had the highest prevalence of atrial flutter (32.6%), coronary artery disease (29.1%), diabetes mellitus (18.4%) and previous myocardial infarction (8.5%). Hypertension was most prevalent in EE (75.4%), as was congestive heart failure (40.4% vs 2.4% in WE). The highest percentage of patients with persistent AF was in NA (32.6%) and longstanding persistent AF was highest in A (16.7%). Pulmonary vein isolation was used alone in most patients (85.8% in NA and 77.5% elsewhere) and radiofrequency was the preferred energy source (63-75% of patients across regions). Use of cryoablation was highest in WE (35.3%). The procedure duration was longer in NA (NA, 228; WE, 176; A, 132; EE, 118 min). The incidence of MBEs is shown in the table.
Conclusions: This subanalysis of the RE-CIRCUIT trial shows that there are distinct differences in the characteristics of patients undergoing AF ablation in different regions. Similarly, AF ablation techniques differ. The benefits of DE over VKA are preserved across all regions.