Uninterrupted Apixaban Administration in Radiofrequency Catheter Ablation for Atrial Fibrillation | Journal Scan

Mar 05, 2015
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Authors:
Di Biase L, Lakkireddy D, Trivedi C, et al.
Citation:
Feasibility and Safety of Uninterrupted Peri-Procedural Apixaban Administration in Patients Undergoing Radiofrequency Catheter Ablation for Atrial Fibrillation: Results From a Multicenter Study. Heart Rhythm 2015;Feb 26:[Epub ahead of print].
Summary By:
Fred Morady, MD, FACC

Study Questions:

Can radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) be performed safely in patients anticoagulated with apixaban?

Methods:

The subjects of this study were 200 consecutive patients (mean age 65.9 years, 71% males) who underwent RFCA of AF (non-paroxysmal in 83%) while anticoagulated with apixaban, 2.5 or 5 mg twice daily. Two hundred age- and gender-matched patients who underwent RFCA of AF while anticoagulated with warfarin served as a control group. Apixaban was administered the morning and night of the procedure day. All patients received heparin during the procedure to maintain an activated clotting time >300 seconds. Twenty-nine apixaban patients underwent brain magnetic resonance imaging (MRI) within 48 hours pre- and post-ablation. All complications occurring within 30 days post-ablation were noted.

Results:

There were no new ischemic lesions post-ablation in any of the 29 patients who underwent MRIs. Major bleeding complications (pericardial tamponade) were equally prevalent in the apixaban (1%) and control (0.5%) groups. There also was not a significant difference in minor bleeding complications between the apixaban (3.5%) and control (2.5%) groups. Thromboembolic complications did not occur in either group.

Conclusions:

Uninterrupted apixaban during RFCA of AF is effective in preventing clinical and silent thromboemboli to the brain and does not increase the risk of bleeding compared to warfarin.

Perspective:

Because there were only three cases of pericardial tamponade, it is unclear whether uninterrupted apixaban makes management of pericardial tamponade more difficult compared to warfarin. Another important issue that is still unclear is whether there are any advantages or disadvantages of uninterrupted apixaban compared to interrupted apixaban.

Keywords: Atrial Fibrillation, Catheter Ablation, Hemorrhage, Magnetic Resonance Imaging, Thromboembolism, Heparin, Anticoagulants, Cardiac Tamponade, Risk, Primary Prevention, Brain, Control Groups


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