Luigi Di Biase1, David F Briceno2, Chintan Trivedi3, Sanghamitra Mohanty3, Carola Gianni3, J David Burkhardt3, Prasant Mohanty3, Rong Bai3, Sampath Gunda4, Rodney Horton3, Shane Bailey3, Javier E Sanchez3, Amin Al-Ahmad3, Patrick Hranitzky3, G Joseph Gallinghouse3, Yaruva Madhu Reddy4, Jason Zagrodzky3, Richard Hongo5, Salwa Beheiry5, Dhanunjaya Lakkireddy4, Andrea Natale6. 1. Texas Cardiac Arrhythmia Institute at St David Medical Center, Austin, Texas; Albert Einstein College of Medicine at Montefiore Hospital, New York, New York; University of Texas, Department of Biomedical Engineering, Austin, Texas; Department of Cardiology, University of Foggia, Foggia, Italy. 2. Albert Einstein College of Medicine at Montefiore Hospital, New York, New York. 3. Texas Cardiac Arrhythmia Institute at St David Medical Center, Austin, Texas. 4. University of Kansas, Kansas City, Kansas. 5. California Pacific Medical Center, San Francisco, California. 6. Texas Cardiac Arrhythmia Institute at St David Medical Center, Austin, Texas; University of Texas, Department of Biomedical Engineering, Austin, Texas; California Pacific Medical Center, San Francisco, California; Stanford University, Palo Alto, California; Case Western Reserve University, Cleveland, Ohio; Scripps Clinic, San Diego, California,; Dell Medical School, Austin, Texas. Electronic address: dr.natale@gmail.com.
Abstract
BACKGROUND: Transesophageal echocardiography (TEE) is recommended in patients undergoing atrial fibrillation (AF) ablation, but use of this strategy is variable. OBJECTIVE: To evaluate whether TEE is necessary before AF ablation in patients treated with novel oral anticoagulants (NOACs). METHODS: We performed a prospective multicenter registry of AF patients undergoing radiofrequency catheter ablation on uninterrupted NOACs (apixaban and rivaroxaban). All patients were on NOACs for at least 4 weeks before ablation. Heparin bolus was administered to all patients before transseptal catheterization to maintain a target activated clotting time above 300 seconds. A subset of 86 patients underwent brain diffuse magnetic resonance imaging (dMRI) to detect silent cerebral ischemia (SCI). RESULTS: A total of 970 patients (514 [53%] apixaban patients and 456 [47%] rivaroxaban patients) were enrolled for this study. The mean age was 69.5 ± 9.0 years, with 824 patients (85%) having nonparoxysmal AF, and 636 patients (65.6%) were male. The average CHA2DS2-VASc score was 3.01 ± 1.3 and CHADS2 score was ≥2 in 609 patients (62.8%). Intracardiac echocardiogram ruled out left atrial appendage thrombus in all patients whose left atrial appendage was visualized (692, 71%), and detected "smoke" in 407 patients (42%). SCI at postprocedure dMRI was detected in 2.3% (2/86). One thromboembolic event (transient ischemic attack) (0.10%) with positive dMRI occurred in a patient on uninterrupted rivaroxaban with longstanding persistent AF. CONCLUSION: Our study illustrates that performing AF ablation while on uninterrupted apixaban and rivaroxaban without TEE is feasible and safe. This finding has important clinical and economic relevance.
BACKGROUND: Transesophageal echocardiography (TEE) is recommended in patients undergoing atrial fibrillation (AF) ablation, but use of this strategy is variable. OBJECTIVE: To evaluate whether TEE is necessary before AF ablation in patients treated with novel oral anticoagulants (NOACs). METHODS: We performed a prospective multicenter registry of AFpatients undergoing radiofrequency catheter ablation on uninterrupted NOACs (apixaban and rivaroxaban). All patients were on NOACs for at least 4 weeks before ablation. Heparin bolus was administered to all patients before transseptal catheterization to maintain a target activated clotting time above 300 seconds. A subset of 86 patients underwent brain diffuse magnetic resonance imaging (dMRI) to detect silent cerebral ischemia (SCI). RESULTS: A total of 970 patients (514 [53%] apixabanpatients and 456 [47%] rivaroxabanpatients) were enrolled for this study. The mean age was 69.5 ± 9.0 years, with 824 patients (85%) having nonparoxysmal AF, and 636 patients (65.6%) were male. The average CHA2DS2-VASc score was 3.01 ± 1.3 and CHADS2 score was ≥2 in 609 patients (62.8%). Intracardiac echocardiogram ruled out left atrial appendage thrombus in all patients whose left atrial appendage was visualized (692, 71%), and detected "smoke" in 407 patients (42%). SCI at postprocedure dMRI was detected in 2.3% (2/86). One thromboembolic event (transient ischemic attack) (0.10%) with positive dMRI occurred in a patient on uninterrupted rivaroxaban with longstanding persistent AF. CONCLUSION: Our study illustrates that performing AF ablation while on uninterrupted apixaban and rivaroxaban without TEE is feasible and safe. This finding has important clinical and economic relevance.
Authors: A Tsyganov; A Shapieva; V Sandrikov; S Fedulova; S Mironovich; A Dzeranova; E Lyan Journal: BMC Cardiovasc Disord Date: 2017-06-29 Impact factor: 2.298
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Authors: Adrian Springer; Ruben Schleberger; Florian Oyen; Boris A Hoffmann; Stephan Willems; Christian Meyer; Florian Langer; Renate B Schnabel; Paulus Kirchhof; Reinhard Schneppenheim; Marc D Lemoine Journal: Clin Appl Thromb Hemost Date: 2021 Jan-Dec Impact factor: 2.389
Authors: Mohamed Al Rawahi; Michelle Samuel; Christos Galatas; Jacqueline Joza; Pedro Y Lima; Rodrigo Barbosa; George Thanassoulis; Martin L Bernier; Thao Huynh; Vidal Essebag Journal: CJC Open Date: 2019-07-02