Results
One hundred thirty-seven patients (mean age 55.0±13.4, 29.1% female)
underwent 230 catheter ablations for AF (1.7±1.0 per patient). A total
of 55 patients (39.4%) underwent 70 procedures (30.4%) on NOAC, the
remaining were ablated while on VKAs. Warfarin (97.6%) and rivaroxaban
(56.4%) were the most frequently used agents in the respective groups.
VKA interruption regimen with low-molecular weight heparin bridging was
adopted in 56 catheter ablations (35%). NOAC use was uninterrupted
pre-procedure in all patients but one (no heparin bridging was performed
either). Pre-procedural TOE was performed for 40 and 125 ablations in
the NOAC and VKA group (57.1% vs. 78.1%, respectively;
p<0.001); 3 procedures in the VKA group were deferred due to
the presence of intracardiac thrombus (p=0.55), despite at least two INR
measurements >2 in the 4 weeks pre ablation. Most patients
had paroxysmal AF (57.5%) at baseline, and mean AF duration was 3.3±3.1
years. Mean CHA2DS2VASc and HAS-BLED
score were 1.5±1.5 and 0.8±0.9, respectively. As many as 10.4% had a
history of stroke or TIA, and 3.6% was on concomitant single
antiplatelet therapy. Mean left atrial diameter was 47±7mm.
Some differences were found at baseline population between the two
groups: left ventricular ejection fraction, wall thickness and outflow
tract gradient were higher in subjects on NOAC; patients on VKA more
frequently presented with persistent AF or had history of previous
surgical myectomy. Detailed baseline characteristics are reported in
Table 1.