Real-world clinical practice of current periprocedural anticoagulation management in catheter ablation of atrial fibrillation: Data from a large prospective ablation registry

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia Pub Date : 2025-01-14 DOI:10.1002/joa3.13182

Yuta Taomoto MD, Shinsuke Miyazaki MD, FHRS, Yasutoshi Nagata MD, Junichi Nitta MD, Osamu Inaba MD, Yasuhiro Shirai MD, Yasuaki Tanaka MD, Yukio Sekiguchi MD, Yukihiro Inamura MD, Yuichiro Sagawa MD, Akira Mizukami MD, Koji Azegami MD, Shinsuke Iwai MD, Hitoshi Hachiya MD, Yuichi Ono MD, Atsushi Takahashi MD, Takeshi Sasaki MD, Yasuteru Yamauchi MD, Hiroyuki Okada MD, Atsushi Suzuki MD, Makoto Suzuki MD, Keita Handa MD, Kenzo Hirao MD, Jun Nakajima MD, Takuro Nishimura MD, Susumu Tao MD, Masateru Takigawa MD, Tetsuo Sasano MD

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Abstract

Background

The guidelines recommend anticoagulation management with uninterrupted warfarin or direct thrombin inhibitors (DTIs) during the atrial fibrillation (AF) ablation periprocedural period.

Objectives

To clarify the Japanese real-world latest periprocedural anticoagulation management during AF ablation.

Methods

This multicenter observational study included 6232 consecutive AF patients (68.7 ± 10.9 years, 4346 men) who underwent periprocedural anticoagulation therapy using direct oral anticoagulants (DOACs) between January 2022 and August 2023.

Results

The mean CHADS₂ and CHA₂DS₂VASc scores were 1.2 ± 1.1 and 2.3 ± 1.5. Bleeding and thromboembolic events occurred in 79 (1.3%) and eight (0.12%) patients. During the periprocedural period, factor Xa inhibitors (FXaIs) were used in 3063 patients (rivaroxaban in 624, apixaban in 1093, and edoxaban in 1345) and DTIs in 3170 including 2583 in whom DTIs were switched from FXaIs. Both the bleeding (0.85% vs. 1.69%, p = .003) and thromboembolic event rates (0.03% vs. 0.23%, p = .036) were significantly lower in the DTI- than FXaI-group. A multivariate analysis showed periprocedural FXaI use was significantly associated with both bleeding events (odds ratio [OR] = 1.92, 95% confidence interval [CI] = 1.20–3.08, p = .006) and cardiac tamponade (OR = 2.74, 95% CI = 1.27–5.9, p = .01). The interval between the last DOAC administration and the procedure was significantly shorter in the DTI- than FXaI-group (4.2 ± 4.9 vs. 19.3 ± 10.7 h, p < .01). In the FXaI-group, the bleeding rate tended to be lower in the minimally interrupted (n = 2105) than uninterrupted group (n = 821) (1.47% vs. 2.56%, p = .06). Two patients in the uninterrupted FXaI-group required surgical management for cardiac tamponade.

Conclusions

Our multicenter real-world data demonstrated that anticoagulation with DTIs was a reasonable periprocedural anticoagulation regimen to reduce periprocedural complications.

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心房颤动导管消融术中当前围手术期抗凝管理的实际临床实践：来自大型前瞻性消融登记的数据。

背景：指南推荐在房颤消融围手术期使用不间断华法林或直接凝血酶抑制剂（DTIs）进行抗凝治疗。目的：了解日本最新的房颤消融围术期抗凝管理。方法：这项多中心观察性研究包括6232例AF患者（68.7±10.9岁，4346名男性），这些患者在2022年1月至2023年8月期间接受了直接口服抗凝剂（DOACs）的围手术期抗凝治疗。结果：CHADS2和CHA2DS2VASc的平均评分分别为1.2±1.1和2.3±1.5。79例（1.3%）和8例（0.12%）患者发生出血和血栓栓塞事件。在围手术期，3063例患者（624例为利伐沙班，1093例为阿哌沙班，1345例为依多沙班）使用了Xa因子抑制剂（FXaIs）， 3170例患者使用了dti，其中2583例患者的dti由FXaIs转换而来。DTI-组的出血发生率（0.85%比1.69%,p = 0.003）和血栓栓塞事件发生率（0.03%比0.23%,p = 0.036）均显著低于fxai组。多因素分析显示围手术期使用FXaI与出血事件（优势比[OR] = 1.92, 95%可信区间[CI] = 1.20-3.08, p = 0.006）和心脏填塞（OR = 2.74, 95% CI = 1.27-5.9, p = 0.01）均显著相关。DTI-组最后一次DOAC给药与手术的间隔时间明显短于fxai组（4.2±4.9 h vs. 19.3±10.7 h, p n = 2105），明显短于不间断组（n = 821）（1.47% vs. 2.56%, p = 0.06）。不间断fxai组2例患者因心脏填塞需要手术治疗。结论：我们的多中心真实数据表明，dti抗凝治疗是一种合理的围手术期抗凝治疗方案，可减少围手术期并发症。

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