Introduction: Limited data are available demonstrating the safety of novel oral anticoagulants (NOAC) in patients undergoing pulmonary vein isolation (PVI) for atrial fibrillation (AF).
Methods: Overall 308 consecutive patients were pretreated four weeks either by uninterrupted vitamin K antagonists (VKA) or NOAC (dabigatran n=35, rivaroxaban n=40; only a single dose withheld the morning of the PVI). Post ablation the NOAC therapy was continued immediately after sheath removal. VKA- treated patients with INR <2.0 received enoxaparin bridging until therapeutic INR (2.0-3.0) was reached. Bleeding and embolic complications were classified according to the 2012 HRS/EHRA/ECAS Expert Consensus Statement on AF ablation.
Results: The total incidence of bleeding complication was significantly reduced for patients treated with NOAC (tab. 1). Especially vascular access complications occurred more often under VKA treatment plus Heparin bridging.
There were no cases of tamponade and no embolic events in either group.
Conclusions: Periinterventional anticoagulation with NOAC was safe and feasible and did not increase embolic or bleeding complications compared to uninterrupted VKA treatment. Further data from randomized controlled trials are needed to prove the safety of this approach.