Periprocedural and long-term safety and feasibility of direct oral anticoagulants in patients with biological valve unde
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Periprocedural and long-term safety and feasibility of direct oral anticoagulants in patients with biological valve undergoing radiofrequency catheter ablation for atrial fibrillation: a prospective multicenter study Luigi Di Biase 1,2 & Jorge Romero 2 & David Briceno 2 & Dhanunjaya Lakkireddy 3 & Chintan Trivedi 1 & Prasant Mohanty 1 & Sanghamitra Mohanty 1 & Rodney Horton 1 & Patrick Hranitzky 1 & G. Joseph Gallinghouse 1 & Isabella Alviz 2 & Mohit Turagam 3 & Rakesh Gopinathannair 3 & Domenico Giovanni Della Rocca 1 & Salwa Beheiry 1 & John David Burkhardt 1 & Juan Viles-Gonzales 4 & Andrea Natale 1 Received: 12 May 2020 / Accepted: 17 July 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Direct oral anticoagulants (DOACs) are contraindicated in patients with atrial fibrillation (AF) and mechanical cardiac valves. However, safety and efficacy are controversial in patients with biological cardiac valves. Objective We report the safety and feasibility of periprocedural and long-term treatment with DOACs in patients with biological valves undergoing ablation for AF. Methods A total of 127 patients with AF and biological cardiac valve undergoing CA on uninterrupted DOAC were matched by gender and age with 127 patients with AF and biological cardiac valves undergoing CA on uninterrupted warfarin. All patients were anticoagulated for at least 3–4 weeks prior to ablation with either rivaroxaban (70%) or apixaban (30%), which were continued for at least 3 months and subsequently based on CHA2DS2-VASc score. Results Mean age of the study population was 63.0 ± 10.9 with 66% being male. The majority of patients on NOACs had aortic valve replacement (59%), while mitral valve was replaced in 41% of patients, which did not differ from the matched cohort on coumadin (aortic valve 57% and mitral valve 43%, (p = 0.8) (p = 0.8), respectively). The CHADS2 score was ≥ 2 in 90 patients (71.0%) on DOAC and 86 patients in (68%) the control (p = 0.6) group. Patients underwent ablation predominantly with uninterrupted rivaroxaban [89 (70%)], while the remaining 38 patients (30%) underwent ablation while on apixaban. Two groin hematomas were observed periprocedurally in both groups. No stroke/transient ischemic attack (TIA) was observed both periprocedurally and at long-term follow-up in either group. Conclusion Periprocedural and long-term administration of DOACs in patients with biological cardiac valves undergoing AF ablation appears as safe as warfarin therapy. Keywords Atrial fibrillation . Catheter ablation . Oral anticoagulation . Biological cardiac valve
1 Introduction * Andrea Natale [email protected] 1
Texas Cardiac Arrhythmia Institute, St David Medical Center, 3000 N. I-35, Suite 720, Austin, TX 78705, USA
2
Albert Einstein College of Medicine, Montefiore Hospital, New York, NY, USA
3
Kansas City Heart Rhythm Institute, HCA Midwest Health, Kansas City, MO, USA
4
University of Miami, Coral Gables, FL, USA
Atrial fibrillation (AF) is a rapidly growing epidemic and is asso
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