Limited efficacy of a figure-of-eight suture for hemostasis after cryoballoon atrial fibrillation ablation with uninterrupted oral anticoagulants

Abstract

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 AE1.0 vs.1.7 AE 1.1, p = 0.030), and the CHA2DS2-VASc score (3.2 AE 1.5 vs. 2.6 AE 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.

Optimal interruption time of dabigatran oral administration to ablation (O-A time) in patients with atrial fibrillation: Integrated analysis of 2 randomized controlled clinical trials

“…Since dabigatran can also prolong APTT in a dose-dependent manner [19] , the anticoagulant effect of dabigatran persisted up to the time of vascular puncture in the < 8 h group, which might have led to the increased incidence of major bleeding events. In fact, a recent report showed that the effect of the suture technique at vascular access sites on hemostasis after AF ablation with uninterrupted DOAC was small [20] .…”