Background: Periprocedural venous thromboembolism (VTE) is a rare occurrence but a critical complication after catheter ablation of atrial fibrillation (AF). The aim of this study was to investigate the incidence of symptomatic deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) in patients who underwent AF catheter ablation and received periprocedural oral anticoagulation with direct oral anticoagulants (DOACs).
Methods and Results: A total of 2,191 consecutive patients undergoing AF catheter ablation with periprocedural DOACs were retrospectively analyzed. Two patients (0.091%) experienced symptomatic DVT after the ablation, and no patients had any PTE. One patient was a 72-year-old female who underwent cryoballoon ablation with periprocedural apixaban at a dose of 2.5 mg twice daily. The other patient was a 74-year-old male who underwent HotBalloon ablation and thereafter radiofrequency catheter ablation for recurrent AF with edoxaban at 30 mg once daily. Both DVT patients underwent AF ablation by the right femoral vein approach, and after discharge had right leg pain and swelling on the post-procedural days 4 and 8, respectively. The DVT was treated by increasing the dose of apixaban and changing it from 30 mg/day of edoxaban to 15-30 mg/day of rivaroxaban, and the thrombi completely disappeared in both patients.
Conclusions: AF catheter ablation with periprocedural DOAC treatment revealed an extremely low incidence of symptomatic VTE, which could be successfully treated by increasing the DOAC dose or changing the DOAC type without any additional complications.
Credits: Takehito Sasaki, Kohki Nakamura, Kentaro Minami, Yutaka Take, Keiko Koyama, Eiji Yamashita, and Shigeto Naito