Significant Benefit of Uninterrupted DOACs Versus VKA During Catheter Ablation of Atrial Fibrillation

Jorge Romero, Roberto C. Cerrud-Rodriguez, Isabella Alviz, Juan Carlos Diaz, Daniel Rodriguez, Samiullah Arshad, Luis Cerna, Jose Taveras, Vito Grupposo, Andrea Natale, Mario Garcia, Luigi Di Biase

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Objectives: This study assessed the incremental benefit of uninterrupted direct oral anticoagulants (DOACs) versus uninterrupted vitamin K antagonists (VKAs) for catheter ablation (CA) of nonvalvular atrial fibrillation (NVAF) on 3 primary outcomes: major bleeding events (MBEs), minor bleeding events, and thromboembolic events (TEs). The secondary outcome was post-procedural silent cerebral infarction (SCI) as detected by brain cardiac magnetic resonance. Background: As a class, evidence of the benefits of DOACs versus VKAs during CA of AF is scant. Methods: A systematic review of Medline, Cochrane, and Embase was done to find all randomized controlled trials in which uninterrupted DOACs were compared against uninterrupted VKAs for CA of NVAF. A fixed-effect model was used, except when I2 was ≥25, in which case, a random effects model was used. Results: The benefit of uninterrupted DOACs over VKAs was analyzed from 6 randomized control trials that enrolled a total of 2,256 patients (male: 72.7%) with NVAF, finding significant benefit in MBEs (relative risk [RR]: 0.45; 95% confidence interval [CI]: 0.20 to 0.99; p = 0.05). No significant differences were found in minor bleeding events (RR: 1.12; 95% CI: 0.87 to 1.43; p = 0.39), TEs (RR: 0.75; 95% CI: 0.26 to 2.14; p = 0.59), or post-procedural SCI (RR: 1.09; 95% CI: 0.80 to 1.49; p = 0.58). Conclusions: An uninterrupted DOACs strategy for CA of AF appears to be safer than uninterrupted VKAs with a decreased rate of major bleeding events. There are no significant differences among the other outcomes. DOACs should be offered as a first-line therapy to patients undergoing CA of AF, due to their lower risk of major bleeding events, ease of use, and fewer interactions.

Original languageEnglish (US)
Pages (from-to)1396-1405
Number of pages10
JournalJACC: Clinical Electrophysiology
Volume5
Issue number12
DOIs
StatePublished - Dec 2019

Keywords

  • atrial fibrillation
  • catheter ablation
  • direct oral anticoagulants
  • randomized controlled trials
  • vitamin K antagonists
  • warfarin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Romero, J., Cerrud-Rodriguez, R. C., Alviz, I., Diaz, J. C., Rodriguez, D., Arshad, S., Cerna, L., Taveras, J., Grupposo, V., Natale, A., Garcia, M., & Di Biase, L. (2019). Significant Benefit of Uninterrupted DOACs Versus VKA During Catheter Ablation of Atrial Fibrillation. JACC: Clinical Electrophysiology, 5(12), 1396-1405. https://doi.org/10.1016/j.jacep.2019.08.010