DOACs in AF ablation 39 1. Introduction Catheter ablation is increasingly used for the treatment of symptomatic atrial fibrillation (AF). Although catheter ablation of AF is considered safe, it may be associated with a low risk of stroke. One of the strategies to reduce this risk is to perform AF ablation with continuous oral anticoagulation. This strategy has been shown to be safe and effective with vitamin K antagonists (VKAs) (1). However, there is an increased use of novel oral anticoagulants (NOACs) in the current AF population undergoing catheter ablation. NOACs have several advantages, including a rapid onset of therapeutic range of anticoagulation, predictability of the anticoagulant effect, and relatively short time to reversal of anticoagulation when the medication is withheld (2). Several observational and randomized controlled trials (RCTs) have demonstrated that uninterrupted NOAC is as safe and effective in comparison to uninterrupted VKA in patients undergoing AF ablation (3–13). A recent meta-analysis demonstrated that NOAC was even associated with less major bleeding compared with VKA in pooled RCTs (14). The 2016 ESC guidelines give a class IIa indication to perform AF ablation with continuous oral anticoagulation with either VKA or NOAC (15). However, the uninterrupted NOAC strategy does not reflect current clinical practice as most centers still use a minimally interrupted NOAC strategy (16). There is limited data demonstrating the safety and efficacy of a minimally interrupted NOAC strategy. The aim of the present study was to compare the incidence of bleeding and thromboembolic complications of minimally interrupted NOAC versus uninterrupted VKA in patients undergoing catheter ablation of AF. 2. Methods 2.1 Study population We evaluated consecutive patients who underwent catheter ablation of AF from January 2013 to April 2017 in the Erasmus Medical Center, Rotterdam, the Netherlands. We included patients with 2 specific anticoagulation regimens. The first group included patients who used periprocedural uninterrupted VKA (either acenocoumarol or marcoumar). The strategy of uninterrupted VKA was introduced in our institution at the end of 2012. The second group included patients who used periprocedural minimally interrupted NOAC (1 or 2 doses withheld). In February 2013, our first patient underwent catheter ablation using a minimally interrupted 3
RkJQdWJsaXNoZXIy MTk4NDMw