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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

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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.

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Authors and Affiliations

  1. Texas Cardiac Arrhythmia Institute, St David Medical Center, 3000 N. I-35, Suite 720, Austin, TX, 78705, USA

    Luigi Di Biase, Chintan Trivedi, Prasant Mohanty, Sanghamitra Mohanty, Rodney Horton, Patrick Hranitzky, G. Joseph Gallinghouse, Domenico Giovanni Della Rocca, Salwa Beheiry, John David Burkhardt & Andrea Natale

  2. Albert Einstein College of Medicine, Montefiore Hospital, New York, NY, USA

    Luigi Di Biase, Jorge Romero, David Briceno & Isabella Alviz

  3. Kansas City Heart Rhythm Institute, HCA Midwest Health, Kansas City, MO, USA

    Dhanunjaya Lakkireddy, Mohit Turagam & Rakesh Gopinathannair

  4. University of Miami, Coral Gables, FL, USA

    Juan Viles-Gonzales

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  1. Luigi Di Biase
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Corresponding author

Correspondence to Andrea Natale.

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Conflict of interest

Dr. Di Biase is a consultant for Biosense Webster, Boston Scientific, Stereotaxis and Abbott Medical. Dr. Di Biase received speaker honoraria/travel support from Medtronic, Pfizer, Bristol Meyers Squibb and Biotronik. Dr. Natale is a consultant for Boston Scientific, Biosense Webster, St. Jude Medical, Biotronik and Medtronic. Dr. Burkhardt is a consultant for Biosense-Webster and Stereotaxis. The remaining authors have nothing to disclose.

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Di Biase, L., Romero, J., Briceno, D. et al. 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. J Interv Card Electrophysiol 61, 617–622 (2021). https://doi.org/10.1007/s10840-020-00833-8

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  • DOI: https://doi.org/10.1007/s10840-020-00833-8

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