Postablation cerebral embolisms in balloon‐based atrial fibrillation ablation with periprocedural direct oral anticoagulants: A comparison between cryoballoon and HotBalloon ablation

Nakamura, Kohki; Sasaki, Takehito; Take, Yutaka; Okazaki, Yoshimasa; Inoue, Mitsuho; Motoda, Hiroyuki; Miki, Yuko; Niijima, Katsura; Yamashita, Eiji; Koyama, Keiko; Funabashi, Nobusada; Naito, Shigeto

doi:10.1111/jce.13762

Cited by 9 publications

(9 citation statements)

References 23 publications

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“…A total of 1489 records were found after database searching; 1245 records were reviewed after removing duplicates, including 147 full text articles. Finally, a total of 13 studies (7 randomized, 6 observational) comprising 3595 patients met the inclusion criteria 16–28 (Supporting Information Data Supplement). Majority of the studies defined uninterrupted DOACs as continuing the DOAC during the procedure and interrupted DOAC as a skipped dose on the morning of procedure or 1 day before the procedure with or without bridging (Supporting Information Data Supplement).…”

Section: Resultsmentioning

confidence: 99%

Uninterrupted versus interrupted direct oral anticoagulation for catheter ablation of atrial fibrillation: A systematic review and meta‐analysis

Asad

Akhtar

Jafry

et al. 2021

Cardiovasc electrophysiol

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Introduction To evaluate the safety of uninterrupted versus interrupted direct oral anticoagulation (DOAC) for patients undergoing catheter ablation (CA) of atrial fibrillation (AF). Methods We conducted a systematic search of MEDLINE and EMBASE for randomized controlled trials (RCT) and observational studies comparing uninterrupted versus interrupted DOAC for patients undergoing CA of AF. Primary outcome was major bleeding. Secondary outcomes included minor bleeding, stroke or transient ischemic attack (TIA) or thromboembolism (TE), silent cerebral ischemic events, and cardiac tamponade. Meta‐analysis was stratified by study design. Risk ratios (RR) with 95% confidence intervals were calculated using random effects model and Mantel–Haenszel method was used to pool RR. Results A total of 13 studies (7 randomized, 6 observational) comprising 3595 patients were included. The RCT restricted analysis did not show any difference in terms of major bleeding (risk ratio [RR] = 0.79; [0.35–1.79]), minor bleeding (RR = 0.99 [0.68–1.43]), stroke or TIA or TE (RR = 0.80 [0.19–3.32]), silent cerebral ischemic events (RR = 0.64 [0.32–1.28]), and cardiac tamponade (RR = 0.61 [0.20–1.92]). Observational study restricted analysis showed a protective effect of uninterrupted DOAC on silent cerebral ischemic events (RR = 0.45 [0.31–0.67]) and no difference in other outcomes. Conclusions There is no difference in bleeding and thromboembolic outcomes with uninterrupted versus interrupted DOAC for CA of AF and observational data suggests that uninterrupted DOACs are protective against silent cerebral ischemic lesions.

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Section: Resultsmentioning

confidence: 99%

Uninterrupted versus interrupted direct oral anticoagulation for catheter ablation of atrial fibrillation: A systematic review and meta‐analysis

Asad

Akhtar

Jafry

et al. 2021

Cardiovasc electrophysiol

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“…15,16 Two identi ed studies were excluded due to lack of comparative data. 17,18 See eFigure 1 in the Supplement. The 3 randomized studies were critically appraised by using the Risk of Bias 2.0 Scale, and the 2 observational studies were appraised by using the Newcastle-Ottawa Scale (eTable 1 in the Supplement).…”

Section: Resultsmentioning

confidence: 99%

“…14 Arti cial surface-induced thrombosis is not prevented effectively by DOACs. 14,16,17 Thus, even with UA, intraprocedural unfractionated heparin is required to prevent thromboembolic events. Moreover, there is a hypothesis that dabigatran downregulates expression of antithrombin, with a compensatory prothrombin upregulation leading to diminution of unfractionated heparin effect.…”

Section: Thrombosis Riskmentioning

confidence: 99%

Outcomes of Uninterrupted vs Interrupted Periprocedural Direct Oral Anticoagulants in Atrial Fibrillation Ablation: A Meta-Analysis

Basu‐Ray

Khanra

Kupó

et al. 2020

Preprint

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BACKGROUND: Studies indicate that uninterrupted anticoagulation is superior to interrupted anticoagulation in the periprocedural period during catheter ablation of atrial fibrillation and has better thromboembolic and hemorrhagic outcomes. Conversely, the few studies addressing the safety and efficacy of interrupted direct oral anticoagulant regimens during catheter ablation of atrial fibrillation are limited by small samples, short follow-up periods, rare events, and variable outcomes. The purpose of this meta-analysis was to compare interrupted and uninterrupted direct oral anticoagulation during catheter ablation of atrial fibrillation.METHODS: A systematic search into PubMed, EMBASE, and the Cochrane databases were performed and five studies were selected that directly that directly compared interrupted versus uninterrupted anticoagulation before ablation and reported procedural outcomes and embolic and bleeding events. The primary outcome of the study was major adverse cerebrocardiovascular events which was a composite of stroke/ transient ischemic attacks and major bleedings, total bleeding which was a composite of major and minor bleedings and silent cerebral events.RESULTS The meta-analysis included 840 patients with uninterrupted anticoagulation and 938 patients with interrupted anticoagulation. Median follow-up was 30 days. Baseline parameters were similar between groups. Activated clotting time before first heparin bolus was significantly longer with uninterrupted anticoagulation (P=.006), whereas mean activated clotting time was similar between the 2 groups (P=.19). Total heparin dose needed was significantly higher with interrupted anticoagulation (mean, ‒1.61; 95% CI, ‒2.67 to ‒0.55; P=.003). Mean procedure time did not vary between groups (P=.81). Overall complication rates were low, with similar major adverse cerebrocardiovascular event (P=.40) and total bleeding (P=.55) rates between groups. Silent cerebral events were significantly more frequent with interrupted anticoagulation (log odds ratio, ‒0.90; 95% CI, ‒1.59 to ‒0.22; P<.01; I2, 33%). Rates of major bleeding, minor bleeding, pericardial effusion, cardiac tamponade, and puncture complications were similar between groups.CONCLUSIONS Uninterrupted anticoagulation during atrial fibrillation ablation has similar bleeding event rates, procedural times, and mean activated clotting times as interrupted anticoagulation, with fewer silent cerebral events.

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“…Unfractionated heparin prevents common extrinsic and intrinsic coagulation pathway activation when administered before septal puncture 14 . Artificial surface‐induced thrombosis is not prevented effectively by DOACs 14,16,27 . Thus, even with UA, intraprocedural unfractionated heparin is required to prevent thromboembolic events.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of uninterrupted vs interrupted Periprocedural direct oral Anticoagulants in atrial Fibrillation ablation: A meta‐analysis

Basu‐Ray

Khanra

Kupó

et al. 2021

Journal of Arrhythmia

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Background Studies indicate that uninterrupted anticoagulation (UA) is superior to interrupted anticoagulation (IA) in the periprocedural period during catheter ablation of atrial fibrillation. Still IA is followed in many centers considering the bleeding risk. This meta‐analysis compares interrupted and uninterrupted direct oral anticoagulation during catheter ablation of atrial fibrillation. Methods A systematic search into PubMed, EMBASE, and the Cochrane databases was performed and five studies were selected that directly compared IA vs UA before ablation and reported procedural outcomes, embolic, and bleeding events. The primary outcome of the study was major adverse cerebro‐cardiovascular events. Results The meta‐analysis included 840 patients with UA and 938 patients with IA. Median follow‐up was 30 days. Activated clotting time (ACT) before first heparin bolus was significantly longer with UA (P = .006), whereas mean ACT was similar between the two groups (P = .19). Total heparin dose needed was significantly higher with IA (mean, ‒1.61; 95% CI, ‒2.67 to ‒0.55; P = .003). Mean procedure time did not vary between groups (P = .81). Overall complication rates were low, with similar major adverse cerebro‐cardiovascular event (P = .40) and total bleeding (P = .55) rates between groups. Silent cerebral events (SCEs) were significantly more frequent with IA (log odds ratio, ‒0.90; 95% CI, ‒1.59 to ‒0.22; P < .01; I2, 33%). Rates of major bleeding, minor bleeding, pericardial effusion, cardiac tamponade, and puncture complications were similar between groups. Conclusions UA during atrial fibrillation ablation has similar bleeding event rates, procedural times, and mean ACTs as IA, with fewer SCEs.

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Postablation cerebral embolisms in balloon‐based atrial fibrillation ablation with periprocedural direct oral anticoagulants: A comparison between cryoballoon and HotBalloon ablation

Cited by 9 publications

References 23 publications

Uninterrupted versus interrupted direct oral anticoagulation for catheter ablation of atrial fibrillation: A systematic review and meta‐analysis

Uninterrupted versus interrupted direct oral anticoagulation for catheter ablation of atrial fibrillation: A systematic review and meta‐analysis

Outcomes of Uninterrupted vs Interrupted Periprocedural Direct Oral Anticoagulants in Atrial Fibrillation Ablation: A Meta-Analysis

Outcomes of uninterrupted vs interrupted Periprocedural direct oral Anticoagulants in atrial Fibrillation ablation: A meta‐analysis

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