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Catheter ablation for atrial fibrillation on uninterrupted direct oral anticoagulants: A safe approach
Author(s) -
Sawhney Vinit,
Shaukat Masooma,
Volkova Elena,
Jones Nicola,
Providencia Rui,
Honarbakhsh Shoreh,
Dhillon Gurpreet,
Chow Anthony,
Lowe Martin,
Lambiase Pier D.,
Dhinoja Mehul,
Sporton Simon,
Earley Mark James,
Schilling Richard John,
Hunter Ross Jacob
Publication year - 2018
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13370
Subject(s) - medicine , atrial fibrillation , dabigatran , apixaban , tamponade , activated clotting time , catheter ablation , warfarin , rivaroxaban , surgery , anesthesia , ablation , hematoma , cardiac tamponade , complication , cardiology , anticoagulant
Abstract Background Current consensus guidelines suggest direct oral anticoagulants (DOACs) are interrupted periprocedurally for catheter ablation (CA) of atrial fibrillation (AF). However, this may predispose patients to thromboembolic complications. This study investigates the safety of CA for AF on uninterrupted DOACs compared to uninterrupted warfarin. Methods This was a single‐center, retrospective study of consecutive patients undergoing CA for AF. All patients were heparinized prior to transseptal puncture with a target‐activated clotting time (ACT) of 300–350 seconds. Patients who had procedures performed on continuous DOAC were compared to those on continuous warfarin. Clinical, procedural data, and complications occurring up to 3 months were analyzed from a prospective registry with additional review of electronic health records. Results A total of 1,884 procedures were performed over 28 months: 761 (609 patients) on uninterrupted warfarin and 1,123 (900 patients) on uninterrupted DOAC (rivaroxaban 64%, apixaban 32%, and dabigatran 4%). There was no difference in the composite endpoint of death, thromboembolism, or major bleeding complication (2.2% vs 1.4%, P = 0.20). There was no difference in the complications comprising this, including tamponade, hematoma, pseudoaneurysm, and transfusion (P‐values 0.28, 0.13, 0.45, and 0.36). There were no strokes, transient ischemic attacks, or other thromboembolic complications. There was no difference between groups in the proportion of tamponades requiring reversal of oral anticoagulation, the volume of blood lost, the proportion transfused, or the proportion drained percutaneously (P‐values 0.50, 0.51, 0.36, and 0.38). Conclusion Catheter ablation for AF can be performed safely and effectively in patients anticoagulated with DOACs and heparinized with a therapeutic ACT. There is no increased risk of periprocedural bleeding when compared to uninterrupted warfarin.