Real-life safety of atrial flutter ablation in the era of NOACs. The French Global Flutter Study - 06/01/20
, D. Mlayeh 1, R. Garcia 2, A. Ramonatxo 2, J. Taieb 3, F. Jourda 4, C. Falaise 5, F. Georger 6, A. Milhem 5
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Résumé |
Background |
Cavotricuspid isthmus (CTI) radiofrequency ablation (RFA) is considered a first-line therapy to achieve rhythm control in patients with typical atrial flutter (AFL).
Aim |
Determine the incidence and risk factors for developing bleeding complications in patients takingnon-vitamin K anticoagulants (NOAC) versus vitamin K antagonists (VKA) and undergoing an atrial flutter catheter ablation in everyday clinical practice.
Methods |
It is a multicenter, observational, prospective study of patients with AFL undergoing a CTI RFA. Eligible patients had been taking apixaban (2.5 or 5mg twice daily), rivaroxaban (15 or 20mg once daily), dabigatran (110 or 150 twice daily) or VKA for ≥3 weeks before the procedure, and were followed for 30 days afterwards.
Results |
A total of 477 patients, 69,7±10.9 [interquartile range 29, 96] years, 80% male, mean CHA2DS2-VASc score 2.4±1.5 were enrolled at 25 academic/nonacademic centres in France. 84 patients (17.6%) were receiving rivaroxaban (68 patients on 20mg/day, and 16 patients on 15mg/day). 89 (18.6%) patients were receiving dabigatran 65 patients on 300mg/day and 24 on 220mg/day. 244 (51.15%) patients were receiving apixaban (210 on 10mg/day, and 34 patients on 5mg/day). 60 (12.57) patients were receiving VKA. The mean INR before procedure was 2.7±1.8. The most prevalent concomitant disorders were hypertension (53%), diabetes (20%) and vascular disease 87 (18%). Mean creatinine concentration was 98±45micromol/L, median weight was 84±18kg and mean creatinine clearance (Cockcroft-Gault) was 80±33mL/min. Overall, 28 patients were switched to unfractionated heparin or enoxaparin. The median duration of switch was 6±14hours. Complications were reported at 30 days, and included only 1 (1.6%) bleeding event in patient receiving VKA (hematoma).
Conclusion |
Every day practice of AFL ablation in patients receiving NOACs is safe. No complications were reported in these patients on NOACs.
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Vol 12 - N° 1
P. 111 - janvier 2020 Retour au numéro
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