Search

It is unclear whether uninterrupted oral anticoagulants (OACs) are acceptable in elderly patients as compared to non-elderly patients. This study aimed to assess the clinical impact of an uninterrupted OAC strategy during atrial fibrillation (AF) ablation in elderly patients. We enrolled 439 consecutive patients who underwent AF ablation with an uninterrupted OAC strategy at our institute. The incidence of bleeding and thromboembolic complications during the AF ablation or within 4 weeks after and the anticoagulation status during the AF ablation were compared between the elderly (age ≧ 75, n = 144) and non-elderly groups (n = 295). There were 22 bleeding complications in the elderly group and 31 in the non-elderly group (15% vs. 11%, p = 0.162) and 3 major bleeding complications in the elderly group and 2 in the non-elderly group (2% vs. 0.7%, p = 0.336). Thromboembolic events were observed in 1 patient in the elderly group and 2 in the non-elderly group (0.7% vs. 0.7%, p = 1.000). The ACT at the end of the procedure was longer in the elderly group than in the non-elderly group (350 s vs. 341 s, p = 0.007) and the proportion of a prolonged ACT of > 400 s (27% vs. 18%, p = 0.046) was more frequent in the elderly group than non-elderly group. A propensity score matched population excluding the age and body weight, revealed that the anticoagulation status during AF ablation was comparable between the two groups. Thus, in the patients undergoing AF ablation with uninterrupted OAC strategy, bleeding complications in elderly patients were similar to those in non-elderly patients. The anticoagulation status during the procedure in elderly patients was more prolonged than that in non-elderly patients.

Introduction: There are limited data on the efficacy and safety of a figure-of-eight (FoE) suture technique after atrial fibrillation (AF) ablation with uninterrupted oral anticoagulants (OACs). This study evaluated the predictors of bleeding complications at the femoral puncture site after placing a FoE suture to achieve hemostasis after AF ablation with OACs., Methods: We enrolled 287 consecutive patients who underwent a 1st session of AF ablation using radiofrequency or cryoballoon ablation. Hemostasis of the femoral puncture site was achieved using the FoE suture technique followed by a 4-h bed rest. We compared the various factors that might be correlated with bleeding complications between the patients with bleeding and those with non-bleeding complications., Results: The bleeding complications were observed in 31 patients (11%). In the univariate analysis, cryoballoon ablation (52% vs. 29%, p = 0.009), HAS-BLED score (2.1 ± 1.0 vs. 1.7 ± 1.1, p = 0.030), and the CHA2DS2-VASc score (3.2 ± 1.5 vs. 2.6 ± 1.6, p = 0.049) were significantly associated with bleeding complications at the femoral puncture site. In the multivariate logistic regression analysis after an adjustment for antiplatelet therapy, cryoballoon ablation was an independent predictor of an increased incidence of the bleeding complications at the femoral puncture site (odds ratio 2.77, 95% CI 1.29-6.02, p = 0.009)., Conclusion: Cryoballoon AF ablation was correlated with bleeding complications after a FoE suture technique with uninterrupted OACs., (Copyright © 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

Background: Recent several studies demonstrated that uninterrupted oral anticoagulants (OAC) strategy during atrial fibrillation (AF) ablation was acceptable and safe. However, these trial numbers were limited and predictors of adverse events were not fully investigated. The aim of this study was to assess predictors of adverse events during atrial fibrillation ablation with uninterrupted oral anticoagulants strategy. Methods: We enrolled 219 consecutive patients who underwent initial AF ablation with uninterrupted OAC strategy in our institute. The incidence of thromboembolic events and bleeding events for 4 weeks after the procedure were assessed. Thromboembolic events were defined as the presence of deep vein thrombus, cerebral infarction and transient ischemic attack. Bleeding events were defined as any bleeding event requiring blood transfusion or surgical intervention, pericardial effusion with tamponade requiring drainage. In addition, a fall in hemoblobin level of 2 g/dl or more 2 days after the procedure was included in bleeding events. We assessed predictors of adverse events with following parameters: the incidence of male, paroxysmal atrial fibrillation, structural heart disease, ischemic heart disease (IHD), chronic kidney disease, hypertension, diabetes mellitus, estimated glomerular filtration rate (eGFR), the echocardiographic parameters including left ventricular ejection fraction and left atrial dimension, ablation methods and activated clotting time. Results: Thromboembolic event was observed in 1 (0.5%) patient and bleeding events were observed in 41 patients (19%), respectively. Multivariate analysis using IHD and eGFR which showed p<0.1 by univariate analysis revealed that only IHD was significantly correlated to bleeding events (table). Conclusion: We should pay attention for bleeding events in the patients with IHD, when we perform catheter ablation of AF with the uninterrupted OAC strategy. [ABSTRACT FROM AUTHOR]

Background: Recent several studies demonstrated that uninterrupted oral anticoagulants (OAC) strategy during atrial fibrillation (AF) ablation was acceptable and safe. However, these trials did not include enough proportions of elderly patients. The aim of this study is to assess the clinical impact of uninterrupted OAC strategy during AF ablation in the elderly patients. Methods: We enrolled 219 consecutive patients who underwent initial AF ablation with uninterrupted OAC strategy in our institute. We compared the incidence of male, paroxysmal atrial fibrillation, structural heart disease, ischemic heart disease, chronic kidney disease, hypertension, diabetes mellitus, the echocardiographic parameters including left ventricular ejection fraction and left atrial dimension, antiplatelet therapy, ablation methods, activated clotting time, thrombotic and bleeding events between elderly group (age≥75years old) and non-elderly group. The incidence of thromboembolic events and bleeding events for 4 weeks after the procedure were assessed. Thromboembolic events were defined as the presence of deep vein thrombus, cerebral infarction and transient ischemic attack. Bleeding events were defined as any bleeding event requiring blood transfusion or surgical intervention, pericardial effusion with tamponade requiring drainage. In addition, a fall in hemoblobin level of 2 g/dl or more 2 days after the procedure was included in bleeding events. Results: Elderly group consisted of 77 patients (35.2%). The incidence of chronic kidney disease, hypertension and average of activated clotting time were significantly higher in elder group than non-elderly group while there were no significant differences of the other parameters between the two groups (table). Thromboembolic event was observed in 1 patient (1%) in elderly group and not observed in non-elderly group (p=0.148). Bleeding events were observed in 11 patients (14%) in elderly group and in 30 patients (21%) in non-elderly group (p=0.199). Conclusion: In patients undergoing catheter ablation of AF, the uninterrupted OAC strategy in elderly patients was acceptable and safe. [ABSTRACT FROM AUTHOR]