Maine Medical Center, Medical Education, Maine Medical Center Research Institute, Cardiology
Humans, Atrial Fibrillation, Feasibility Studies, Catheter Ablation
Background: Atrial fibrillation (AF) ablation in the setting of uninterrupted anticoagulation (AC) has been studied by large university based medical centers in randomized controlled trials. This strategy has not been looked at in a clinical based Electrophysiology (EP) program at a tertiary hospital.
Methods: Patients aged 18 years or older who presented to Maine Medical Center and captured in the American Heart Association (AHA) Get With The Guidelines: Afib database between 1/1/2015 and 6/1/2019 were eligible. Inclusion criteria were any patient with a left side AF procedure (Pulmonary vein isolation [PVI] or other lesions). Patients were excluded if follow-up data were incomplete. We compared subgroup data in bivariate analyses using Pearson?s chi-square test or Fisher?s exact test for categorical data and ANOVA or Kruskal-Wallis test for continuous data.
Results: 586 eligible AF procedures were performed over a 4.5-year period. Anticoagulants prescribed to patients included warfarin and three direct oral anticoagulants (DOACs): apixaban, dabigatran, and rivaroxaban. 68.2% of patients continued AC uninterrupted, and 31.7% of patients had brief interruption of 1-2 doses at the time of ablation. Major complications between the groups were not different despite the different baseline characteristics, anticoagulation strategies, and mean CHADs2-Vasc (C2V) scores (mean C2V scores were 1.8, 2.1, 2.8 for uninterrupted DOAC, interrupted DOAC, and warfarin groups, respectively, p<0.001).
Conclusion: This study suggests the strategy of uninterrupted or minimally interrupted periprocedural anticoagulation is safe and effective in a large clinical electrophysiology practice.
Janes, William Adam; Craig, Wendy; Cunningham, Kyle; Knutson, Jill; Haskell, Amanda; and Sesselberg, Henry, "Feasibility and safety of uninterrupted and nearly uninterrupted DOAC use in patients undergoing radiofrequency ablation for atrial fibrillation in a tertiary community medical center" (2020). Costas T. Lambrew Research Retreat 2020. 53.