Catheter ablation for atrial fibrillation on uninterrupted direct oral anticoagulants: A safe approach

Vinit, Sawhney; Shaukat, Masooma; Волкова, Е. В.; Jones, Nicola L.; Providência, Rui; Honarbakhsh, S; Dhillon, Gurpreet; Chow, Anthony W.; Lambiase, Pier D.; Dhinoja, Mehul; Sporton, Simon; Earley, Mark J.; Schilling, Richard J.; Hunter, Ross J.

doi:10.1111/pace.13370

Cited by 6 publications

(4 citation statements)

References 23 publications

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“…In fact, both manipulations of the catheters and creation of lesions inside the left atrium can lead to local thrombus formation 7 . There is a significant body of evidence showing that NOACs can be safely used in patients undergoing catheter ablation of AF, with a similar or lower rate of bleeding and thromboembolic complications compared with VKA 7,25 . The RE‐CIRCUIT, 26 VENTURE‐AF, 27 and AXAFA 28 trials have, respectively, demonstrated the safety and efficacy of uninterrupted dabigatran, rivaroxaban, and apixaban during catheter ablation of AF.…”

Section: Discussionmentioning

confidence: 99%

Non–vitamin K oral anticoagulants in hypertrophic cardiomyopathy patients undergoing catheter ablation of atrial fibrillation

Creta

Hunter

Earley

et al. 2020

Cardiovasc electrophysiol

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Introduction: Patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF) require chronic anticoagulation due to high thromboembolic risk. Evidence supporting the use of non-vitamin K oral anticoagulants (NOACs) in patients with HCM remains sparse, and there are no data regarding the use of NOACs in patients with HCM undergoing catheter ablation of AF. Methods: Observational nonrandomized study in four European centers. We aimed to investigate the safety and efficacy of NOACs compared with vitamin K antagonists (VKAs) in patients with HCM undergoing catheter ablation for AF. Results: A total of 137 patients with HCM (mean age: 55.0 ± 13.4, 29.1% female) underwent 230 catheter ablations for AF (1.7 ± 1.0 per patient). A total of 55 patients (39.4%) underwent 70 procedures (30.4%) on NOAC, while the remaining were on VKA. Warfarin (97.6%) and rivaroxaban (56.4%) were the most frequently used agents in the respective groups. No procedure-related deaths were reported. We observed no significant difference in the rate of thromboembolism (VKA: 0.6%; NOAC: 0%; p = 1.0) or minor bleeding (VKA: 0.6%; NOAC: 1.4%; p = .54). There was a nonsignificant trend towards a lower incidence of major bleeding (VKA: 6.9%; NOAC: 1.4%; p = .09). Conclusion: These preliminary data suggest that NOACs are at least as safe and effective as VKAs in patients with HCM undergoing catheter ablation for AF.

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Section: Discussionmentioning

confidence: 99%

Non–vitamin K oral anticoagulants in hypertrophic cardiomyopathy patients undergoing catheter ablation of atrial fibrillation

Creta

Hunter

Earley

et al. 2020

Cardiovasc electrophysiol

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“… 19 Sawhney V et al compararam os DOAC (64% rivaroxabana) à varfarina, ininterruptos em 1.884 procedimentos de ablação de FA e não encontraram diferença entre os grupos em relação ao desfecho primário, composto por morte, TE ou sangramentos maiores (2,2% vs. 1,4%; p = 0,2). 20 Com esses resultados, agora mais consistentes, a ablação por cateter da FA sob uso ininterrupto de varfarina, dabigatrana ou rivaroxabana passou a ter recomendação classe I no último consenso de especialistas (HRS, EHRA, ECAS, APHRS, SOLAECE), publicado em 2017. 1 …”

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Section: Discussionmentioning

confidence: 99%

“…19 Sawhney V et al compared DOAC (64% rivaroxaban) to warfarin, uninterrupted in 1884 AF ablation procedures, and found no difference between the groups in relation to the primary outcome consisting of death, TE or major bleedings (2.2% vs. 1.4% p = 0.2). 20 With these now more consistent results, catheter ablation of AF under uninterrupted use of warfarin, dabigatran or rivaroxaban is now class I recommendation in the latest expert consensus (HRS, EHRA, ECAS, APHRS, SOLAECE), published in 2017. 1 In our service, which has 14 years of experience in AF ablation, with current 50 to 100 procedures/year, after a long period using uninterrupted warfarin (therapeutic INR) for AF ablation, we chose rivaroxaban as an alternative based on the presented results, in a major adaptation to our routine, to the preoperative group protocol and drug pharmacokinetics.…”

Section: Discussionmentioning

confidence: 99%

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Segurança da Ablação por Cateter de Fibrilação Atrial sob Uso Ininterrupto de Rivaroxabana

et al. 2020

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Fundamento: A ablação de fibrilação atrial (FA) sob uso ininterrupto de varfarina é segura e recomendada por especialistas. Entretanto, há controvérsia quanto aos anticoagulantes orais de ação direta para o mesmo fim. Objetivo: Avaliar a segurança em realizar ablação de FA sob anticoagulação ininterrupta com rivaroxabana. Métodos: Uma série de 130 pacientes foi submetida à ablação com radiofrequência da FA sob uso ininterrupto de rivaroxabana (grupo RIV) e comparada a um grupo-controle de 110 pacientes que a fizeram sob uso ininterrupto de varfarina (grupo VRF) e relação normatizada internacional (RNI) terapêutica. Analisamos morte, taxas de eventos tromboembólicos, de sangramentos maiores e menores, níveis do tempo de coagulação ativado (TCA) e dose de heparina no procedimento. O protocolo da ablação consistiu basicamente em isolamento circunferencial das veias pulmonares guiado por mapeamento eletroanatômico. Significância estatística de 5% foi adotada. Resultados: As características clínicas dos grupos foram semelhantes e a FA paroxística mais frequente (63% e 59%, grupos RIV e VRF). Um evento tromboembólico ocorreu no grupo RIV. Foram três pacientes com sangramentos maiores (RIV = 1 e VRF = 2; p = 0,5); nenhum óbito. A RNI basal foi maior no grupo VRF (2,5 vs. 1,2 ± 0,02; p < 0,0001), com níveis de TCA basal semelhantes (123,7 ± 3 vs. 118 ± 4; p = 0,34). Maior dose de heparina venosa foi utilizada no grupo RIV (9.414 ± 199 vs. 6.019 ± 185 UI; p < 0,0001) para manter níveis médios de TCA semelhantes durante o procedimento (350 ± 3 vs. 348,9 ± 4; p = 0,79). Conclusão: Na população estudada, a ablação de FA sob rivaroxabana ininterrupta teve segurança equivalente à varfarina ininterrupta, com RNI terapêutica. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

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Effects of rivaroxaban on activated clotting time in catheter ablation for atrial fibrillation in Chinese patients

Huang

Guo

Huang

et al. 2019

J Interv Card Electrophysiol

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Catheter ablation for atrial fibrillation on uninterrupted direct oral anticoagulants: A safe approach

Abstract: 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.

Cited by 6 publications

References 23 publications

Non–vitamin K oral anticoagulants in hypertrophic cardiomyopathy patients undergoing catheter ablation of atrial fibrillation

Non–vitamin K oral anticoagulants in hypertrophic cardiomyopathy patients undergoing catheter ablation of atrial fibrillation

Segurança da Ablação por Cateter de Fibrilação Atrial sob Uso Ininterrupto de Rivaroxabana

Effects of rivaroxaban on activated clotting time in catheter ablation for atrial fibrillation in Chinese patients

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