Apixaban, rivaroxaban, and dabigatran use in patients undergoing catheter ablation for atrial fibrillation using the second-generation cryoballoon
Verena Tscholl1, Abdullah Khaled-A Lsharaf1, Tina Lin2
1Department of Cardiology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
Background:
Data are limited on the safety of periprocedural anticoagulation with novel oral anticoagulants (NOACs) in patients undergoing pulmonary vein isolation (PVI) using the second-generation cryoballoon (CB) for the treatment of atrial fibrillation.
Hypothesis:
We hypothesized that the incidence of acute periprocedural complications in patients undergoing PVI do not differ between patients treated with VKA compared to NOACs.
Methods:
In 200 consecutive patients (mean age, 64.3 _ 10.6 years; female, n = 83) with symptomatic atrial fibrillation, PVI using the second-generation 28-mm CB was performed. In patients treated with NOACs, the medication was stopped the day of the procedure and continued the evening after the procedure with a reduced dosage. Patients treated with phenprocoumon were continued on uninterrupted phenprocoumon with a target INR of 2 to 3. If INR was <2, bridging with low-molecular-weight heparin was performed.
Results:
Forty-seven of 200 patients (23.5%) were treated with a vitamin K antagonist (VKA) and 55 (27.5%) were treated with apixaban, 67 (33.5%) with rivaroxaban, and 31 (15.5%) with dabigatran. Seven (3.5%) major complications occurred in the overall population. Major bleeding complications did not differ significantly between the 2 groups (P = 0.23). One patient taking VKA had a pericardial tamponade at the end of the procedure; 2 patients treated with apixaban developed a groin hematoma requiring surgical intervention. Transient ischemic attack occurred in 1 patient of the apixaban and rivaroxaban group.
Conclusions:
Apixaban, rivaroxaban, and dabigatran, compared with uninterrupted VKA, did not show a higher risk for major bleeding or ischemic complications in patients undergoing PVI using the second-generation CB.
Insights
Novel oral anticoagulants (NOACs) show similar safety to vitamin K antagonists (VKAs) for periprocedural anticoagulation during atrial fibrillation cryoballoon ablation. This study found no increased risk of major bleeding or ischemic events with NOACs in PVI procedures.
Area of Science:
- Cardiology
- Electrophysiology
- Anticoagulation Therapy
Background:
- Limited data exists on novel oral anticoagulants (NOACs) safety during pulmonary vein isolation (PVI) with second-generation cryoballoon (CB).
- Understanding periprocedural anticoagulation strategies is crucial for atrial fibrillation management.
Purpose of the Study:
- To compare the incidence of acute periprocedural complications between NOACs and vitamin K antagonists (VKAs) during PVI.
- To evaluate the safety of NOACs in patients undergoing second-generation CB ablation for atrial fibrillation.
Main Methods:
- A study of 200 patients undergoing PVI with second-generation CB for symptomatic atrial fibrillation.
- Patients received either NOACs (stopped day of procedure, resumed evening after) or uninterrupted VKA (target INR 2-3), with LMWH bridging if INR <2.
- Complication rates were compared between the VKA and NOAC groups.
Main Results:
- Seven major complications (3.5%) occurred in 200 patients; no significant difference in major bleeding between VKA and NOAC groups (P=0.23).
- Specific events included pericardial tamponade (VKA), groin hematoma (apixaban), and transient ischemic attack (apixaban, rivaroxaban).
- NOACs included apixaban (27.5%), rivaroxaban (33.5%), and dabigatran (15.5%); 23.5% received VKA.
Conclusions:
- Apixaban, rivaroxaban, and dabigatran are not associated with a higher risk of major bleeding or ischemic complications compared to uninterrupted VKA.
- NOACs represent a safe alternative for periprocedural anticoagulation in PVI using second-generation cryoballoon.
- These findings support current guidelines for anticoagulation management in atrial fibrillation ablation.
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