TY - JOUR
T1 - Is transesophageal echocardiography necessary in patients undergoing ablation of atrial fibrillation on an uninterrupted direct oral anticoagulant regimen? Results from a prospective multicenter registry
AU - Patel, Kavisha
AU - Natale, Andrea
AU - Yang, Ruike
AU - Trivedi, Chintan
AU - Romero, Jorge
AU - Briceno Gomez, David F.
AU - Mohanty, Sanghamitra
AU - Alviz, Isabella
AU - Natale, Veronica
AU - Sanchez, Javier
AU - Della Rocca, Domenico G.
AU - Tarantino, Nicola
AU - Zhang, Xiao Dong
AU - Mohanty, Prasant
AU - Horton, Rodney
AU - Burkhardt, David
AU - Gopinathannair, Rakesh
AU - Joseph Gallinghouse, G.
AU - Lakkireddy, Dhanunjaya
AU - Di Biase, Luigi
N1 - Funding Information:
Medical and has received speaker honoraria/travel support from Medtronic, AtriCure, Bristol Myers Squibb, Pfizer, and Biotronik. Dr Natale is a consultant for Biosense Webster, Stereotaxis, and Abbott and has received speaker honoraria/travel support from Medtronic, AtriCure, Biotronik, and Janssen. The rest of the authors report no conflicts of interest.
Publisher Copyright:
© 2020 Heart Rhythm Society
PY - 2020/12
Y1 - 2020/12
N2 - Background: Thromboembolic stroke is a rare but devastating consequence of atrial fibrillation (AF) ablation. Transesophageal echocardiography (TEE) is recommended to rule out left atrial appendage thrombus; however, its use is variable. Objective: The purpose of this study was to assess whether TEE is mandatory in patients undergoing AF ablation on uninterrupted direct oral anticoagulants (DOACs). Methods: Data from our prospective multicenter registry of patients with AF undergoing radiofrequency catheter ablation on uninterrupted DOACs were analyzed. All the included patients were on anticoagulation for at least 4 weeks before ablation. All AF ablation procedures were performed under intracardiac echocardiography guidance. Before transseptal puncture, heparin bolus was administered, followed by continuous infusion, with a target activated clotting time of >300 seconds. Results: A total of 6186 patients (3180 on apixaban [51.4%], 2528 on rivaroxaban [40.9%], 404 on dabigatran [6.5%], and 74 on edoxaban [1.2%]) were analyzed. The mean age of the study population was 69.4 ± 10.3 years; 4194 patients (67.8%) were male, and 5120 patients (82.8%) had persistent and long-standing persistent AF. The mean CHA2DS2-VASc score was 2.86 ± 1.58; the mean CHADS2 score was 1.65 ± 1.14. Intracardiac echocardiography ruled out left atrial appendage and left atrial thrombi in all patients and revealed “smoke” in 1672 patients (27.03%). Transient ischemic attack was noted in 1 patient with long-standing persistent AF in the setting of a missed dose of rivaroxaban before ablation. Conclusion: Our study showed that performing AF ablation in patients on uninterrupted DOACs without TEE is safe and feasible in high stroke risk patients. Elimination of routine preablation TEE would have significant economic and clinical implications.
AB - Background: Thromboembolic stroke is a rare but devastating consequence of atrial fibrillation (AF) ablation. Transesophageal echocardiography (TEE) is recommended to rule out left atrial appendage thrombus; however, its use is variable. Objective: The purpose of this study was to assess whether TEE is mandatory in patients undergoing AF ablation on uninterrupted direct oral anticoagulants (DOACs). Methods: Data from our prospective multicenter registry of patients with AF undergoing radiofrequency catheter ablation on uninterrupted DOACs were analyzed. All the included patients were on anticoagulation for at least 4 weeks before ablation. All AF ablation procedures were performed under intracardiac echocardiography guidance. Before transseptal puncture, heparin bolus was administered, followed by continuous infusion, with a target activated clotting time of >300 seconds. Results: A total of 6186 patients (3180 on apixaban [51.4%], 2528 on rivaroxaban [40.9%], 404 on dabigatran [6.5%], and 74 on edoxaban [1.2%]) were analyzed. The mean age of the study population was 69.4 ± 10.3 years; 4194 patients (67.8%) were male, and 5120 patients (82.8%) had persistent and long-standing persistent AF. The mean CHA2DS2-VASc score was 2.86 ± 1.58; the mean CHADS2 score was 1.65 ± 1.14. Intracardiac echocardiography ruled out left atrial appendage and left atrial thrombi in all patients and revealed “smoke” in 1672 patients (27.03%). Transient ischemic attack was noted in 1 patient with long-standing persistent AF in the setting of a missed dose of rivaroxaban before ablation. Conclusion: Our study showed that performing AF ablation in patients on uninterrupted DOACs without TEE is safe and feasible in high stroke risk patients. Elimination of routine preablation TEE would have significant economic and clinical implications.
KW - Atrial fibrillation
KW - Direct oral anticoagulants
KW - Intracardiac echocardiography
KW - Transesophageal echocardiography
KW - Uninterrupted anticoagulation
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U2 - 10.1016/j.hrthm.2020.07.017
DO - 10.1016/j.hrthm.2020.07.017
M3 - Article
C2 - 32681991
AN - SCOPUS:85092162538
SN - 1547-5271
VL - 17
SP - 2093
EP - 2099
JO - Heart Rhythm
JF - Heart Rhythm
IS - 12
ER -