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

Sawhney, V; Shaukat, M; Volkova, E; Jones, N; Providencia, R; Honarbakhsh, S; Dhillon, G; ... Hunter, RJ; + view all (2018) Catheter ablation for atrial fibrillation on uninterrupted direct oral anticoagulants: A safe approach. Pacing and Clinical Electrophysiology , 41 (8) pp. 1001-1009. 10.1111/pace.13370. Green open access

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Abstract

BACKGROUND: Current consensus guidelines suggest DOACs are interrupted peri-procedurally for catheter ablation (CA) of 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: Single centre, retrospective study of consecutive patients undergoing CA for AF. All patients were heparinised prior to trans-septal 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 analysed from a prospective registry with additional review of electronic health records. RESULTS: 1884 procedures were performed over 28 months: 761(609 patients) on uninterrupted warfarin and 1123(900 patients) on uninterrupted DOAC (rivaroxaban 64%, apixaban 32% and dabigatran 4%). There was no difference in the composite end point 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, haematoma, pseudoaneurysm, transfusion(p-values 0.28, 0.13, 0.45 and 0.36). There were no strokes, TIAs 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, 0.38). CONCLUSION: Catheter ablation for AF can be performed safely and effectively in patients anticoagulated with DOACs and heparinised with a therapeutic ACT. There is no increased risk of peri-procedural bleeding when compared to uninterrupted warfarin. This article is protected by copyright. All rights reserved.

Type: Article
Title: Catheter ablation for atrial fibrillation on uninterrupted direct oral anticoagulants: A safe approach
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/pace.13370
Publisher version: https://doi.org/10.1111/pace.13370
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Atrial fibrillation, catheter ablation, uninterrupted DOACs, uninterrupted warfarin
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science > Clinical Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Health Informatics
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Health Informatics > Clinical Epidemiology
URI: http://discovery.ucl.ac.uk/id/eprint/10049255
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