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Feasibility and safety of uninterrupted apixaban in patients undergoing radiofrequency ablation for atrial fibrillation

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

An optimal periprocedural anticoagulation strategy is essential for minimizing bleeding and thromboembolic complications during atrial fibrillation (AF) ablation. Limited data are available on the uninterrupted use of apixaban in patients with AF undergoing catheter ablation. This study aimed to evaluate the safety and efficacy of uninterrupted apixaban in patients undergoing radiofrequency ablation for AF. In particular, we evaluated silent cerebral infarction (CI) during radiofrequency catheter ablation of AF.

Methods

This was a prospective and nonrandomized cohort study. A total of 259 consecutive patients who underwent AF ablation were evaluated; 157 patients received apixaban (Api group), and 102 patients received dose-adjusted (PT-INR 2.0-3.0) warfarin (Wf group). All oral anticoagulants were continued throughout the periprocedural period, including the morning of the procedure. Intravenous heparin was administered during the procedure and neutralized by protamine at the end of the procedure. Sixty-one patients underwent magnetic resonance imaging (MRI) after the procedure to evaluate for silent CI.

Results

Mean age was 66 ± 11 years; there were 91 men (73.7%) and 148 cases of paroxysmal AF (57.1%). No symptomatic CI was observed. Silent CI occurred in 6/61 patients (9.8%). No significant difference was observed between the Api group (4/30 patients, 13.3%) and the Wf group (2/31 patients, 6.5%). There was no significant difference regarding major bleeding events between the Api group (1/157 patients, 0.6%) and the Wf group (2/102 patients, 2.0%).

Conclusions

The safety and efficacy of uninterrupted apixaban for patients undergoing AF ablation were equivalent to warfarin for preventing bleeding and thromboembolic complications.

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References

  1. Calkins H, Kuck KH, Cappato R, et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Heart Rhythm. 2012;9:632–96.

    PubMed  Google Scholar 

  2. Di Biase L, Burkhardt JD, Santangeli P, et al. Periprocedural stroke and bleeding complications in patients undergoing catheter ablation of atrial fibrillation with different anticoagulation management results from the Role of Coumadin in Preventing Thromboembolism in Atrial Fibrillation (AF) Patients Undergoing Catheter Ablation (COMPARE) randomized trial. Circulation. 2014;129:2638–44.

    PubMed  Google Scholar 

  3. Santangeli P, Di Biase L, Horton R, et al. Ablation of atrial fibrillation under therapeutic warfarin reduces periprocedural complications evidence from a meta-analysis. Circ Arrhythm Electrophysiol. 2012;5:302–11.

    CAS  PubMed  Google Scholar 

  4. Lakkireddy D, Reddy YM, Di Biase L, et al. Feasibility and safety of uninterrupted rivaroxaban for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation: results from a multicenter prospective registry. J Am Coll Cardiol. 2014;63:982–8.

    CAS  PubMed  Google Scholar 

  5. Tao S, Otomo K, Ono Y, et al. Efficacy and safety of uninterrupted rivaroxaban taken preoperatively for radiofrequency catheter ablation of atrial fibrillation compared to uninterrupted warfarin. J Interv Card Electrophysiol. 2017;48:167–75.

    PubMed  Google Scholar 

  6. Cappato R, Marchlinski FE, Hohnloser SH, et al. Uninterrupted rivaroxaban vs. uninterrupted vitamin K antagonists for catheter ablation in non-valvular atrial fibrillation. Eur Heart J. 2015;36:1805–11.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Calkins H, Willems S, Gerstenfeld EP, et al. Uninterrupted dabigatran versus warfarin for ablation in atrial fibrillation. N Engl J Med. 2017;377:495–6.

    PubMed  Google Scholar 

  8. Granger CB, Alexander JH, McMurray JJV, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365:981–92.

    CAS  PubMed  Google Scholar 

  9. Kuwahara T, Abe M, Takahashi A, et al. Apixaban versus warfarin for the prevention of periprocedural cerebral thromboembolism in atrial fibrillation ablation: multicenter prospective randomized study. J Cardiovasc Electrophysiol. 2016;27:549–54.

    PubMed  Google Scholar 

  10. Kirchhof P, Haeusler KG, Blank B, et al. Apixaban in patients at riskof stroke undergoing atrial fibrillation ablation. Eur Heart J. 2018;39:2942–55.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Di Biase L, Lakkireddy D, Trivedi C, et al. Feasibility and safety of uninterrupted periprocedural apixaban administration in patients undergoing radiofrequency catheter ablation for atrial fibrillation: results from a multicenter study. Heart Rhythm. 2015;12:1162–8.

    PubMed  Google Scholar 

  12. Shah RR, Pillai A, Schafer P, et al. Safety and efficacy of uninterrupted apixaban therapy versus warfarin during atrial fibrillation ablation. Am J Cardiol. 2017;120:404–7.

    CAS  PubMed  Google Scholar 

  13. Nagao T, Inden Y, Shimano M, et al. Efficacy and safety of apixaban in the patients undergoing the ablation of atrial fibrillation. Pacing Clin Electrophysiol. 2015;38:155–63.

    PubMed  Google Scholar 

  14. Kaess BM, Ammar S, Reents T, Dillier R, Lennerz C, Semmler V, et al. Comparison of safety of left atrial catheter ablation procedures for atrial arrhythmias under continuous anticoagulation with apixaban versus phenprocoumon. Am J Cardiol. 2015;115:47–51.

    PubMed  Google Scholar 

  15. Kuwahara T, Takahashi A, Kobori A, et al. Safe and effective ablation of atrial fibrillation: importance of esophageal temperature monitoring to avoid periesophageal nerve injury as a complication of pulmonary vein isolation. J Cardiovasc Electrophysiol. 2009;20:1–6.

    PubMed  Google Scholar 

  16. Hachiya H, Hirao K, Takahashi A, et al. Clinical implications of reconnection between the left atrium and isolated pulmonary veins provoked by adenosine triphosphate after extensive encircling pulmonary vein isolation. J Cardiovasc Electrophysiol. 2007;18:392–8.

    PubMed  Google Scholar 

  17. Miyazaki S, Takahashi A, Kuwahara T, Kobori A, Yokoyama Y, Nozato T, et al. Randomized comparison of the continuous vs. point-by-point radiofrequency ablation of the cavotricuspid isthmus for atrial flutter. Circ J. 2007;71:1922–6.

    PubMed  Google Scholar 

  18. Lin WS, Tai CT, Hsieh MH, Tsai CF, Lin YK, Tsao HM, et al. Catheter ablation of paroxysmal atrial fibrillation initiated by non–pulmonary vein ectopy. Circulation. 2003;107:3176–83.

    PubMed  Google Scholar 

  19. Tsai CF, Tai CT, Hsieh MH, Lin WS, Yu WC, Ueng KC, et al. Initiation of atrial fibrillation by ectopic beats originating from the superior vena cava: electrophysiological characteristics and results of radiofrequency ablation. Circulation. 2000;102:67–74.

    CAS  PubMed  Google Scholar 

  20. Higuchi K, Yamauchi Y, Hirao K, Sasaki T, Hachiya H, Sekiguchi Y, et al. Superior vena cava as initiator of atrial fibrillation: factors related to its arrhythmogenicity. Heart Rhythm. 2010;7:1186–91.

    PubMed  Google Scholar 

  21. Estner HL, Hessling G, Ndrepepa G, et al. Acute effects and long-term outcome of pulmonary vein isolation in combination with electrogram-guided substrate ablation for persistent atrial fibrillation. Am J Cardiol. 2008;101:332–7.

    PubMed  Google Scholar 

  22. Schulman S, Kearon C, the Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of The International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost. 2005;3:692–4.

    CAS  PubMed  Google Scholar 

  23. Christian S, Francisco M, David B, et al. Antithrombotic management in patients undergoing electrophysiological procedures: a European Heart Rhythm Association (EHRA) positiondocumentendorsedby the ESC Working Group Thrombosis, Heart Rhythm Society (HRS), and Asia Pacific Heart Rhythm Society (APHRS). Europace. 2015;17:1197–214.

    Google Scholar 

  24. Cheung YW, Barco S, Hutten BA, Meijers JCM, Middeldorp S, Coppens M. In vivo increase in thrombin generation by four-factor prothrombin complex concentrate in apixaban-treated healthy volunteers. J Thromb Haemost. 2015;13:1799–805.

    CAS  PubMed  Google Scholar 

  25. Müller P, Halbfass P, Szöllösi A, et al. Impact of periprocedural anticoagulation strategy on the incidence of new-onset silent cerebral events after radiofrequency catheter ablation of atrial fibrillation. J Interv Card Electrophysiol. 2016;46:203–11.

    PubMed  Google Scholar 

  26. Ichiki H, Oketani N, Ishida S, et al. Incidence of asymptomatic cerebral microthromboembolism after atrial fibrillation ablation guided by complex fractionated atrial electrogram. J Cardiovasc Electrophysiol. 2012;23:567–73.

    PubMed  Google Scholar 

  27. Martinek M, Sigmund E, Lemes C, et al. Asymptomatic cerebral lesions during pulmonary vein isolation under uninterrupted oral anticoagulation. Europace. 2013;15:325–31.

    PubMed  Google Scholar 

  28. Gaita F, Caponi D, Pianelli M, et al. Radiofrequency catheter ablation of atrial fibrillation: a cause of silent thromboembolism? Circulation. 2010;122:1667–73.

    PubMed  Google Scholar 

  29. Erik W, Andreas M, Petr N, et al. Asymptomatic brain lesions following laser balloon-based pulmonary vein isolation. Europace. 2014;16:214–9.

    Google Scholar 

  30. Gregory YHL, Robby N, Ron P, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach, The Euro Heart Survey on Atrial Fibrillation. Chest. 2010;137:263–72.

    Google Scholar 

  31. Guerra JM, Jorge E, Raga S. Effects of open-irrigated radiofrequency ablation catheter design on lesion formation and complications: in vitro comparison of 6 different devices. J Cardiovasc Electrophysiol. 2013;24:1157–62.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Ome Municipal General Hospital, 4-16-5, Higashi Ome, Ome City, Tokyo, 198-0042, Japan

    Yuki Osaka, Yuichi Ono, Kentaro Goto, Toru Miyazaki, Asami Suzuki, Ken Kurihara & Kenichiro Otomo

  2. Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan

    Yuki Osaka, Susumu Tao & Kenzo Hirao

Authors
  1. Yuki Osaka
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  2. Yuichi Ono
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  3. Susumu Tao
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  4. Kentaro Goto
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  5. Toru Miyazaki
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  7. Ken Kurihara
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  8. Kenichiro Otomo
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Correspondence to Yuki Osaka.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Osaka, Y., Ono, Y., Tao, S. et al. Feasibility and safety of uninterrupted apixaban in patients undergoing radiofrequency ablation for atrial fibrillation. J Interv Card Electrophysiol 58, 35–41 (2020). https://doi.org/10.1007/s10840-019-00563-6

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  • DOI: https://doi.org/10.1007/s10840-019-00563-6

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