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Safety of novel oral anticoagulants in catheter ablation of atrial fibrillation.

INTRODUCTION
Limited data are available regarding safety of catheter ablation of atrial fibrillation (AF) in patients using novel oral anticoagulants (NOAC) before and after pulmonary vein isolation. We aimed to assess the safety of a simple anticoagulation protocol in consecutive patients presenting for catheter ablation of AF.


METHODS
From November 2011 to December 2014, we prospectively included 234 patients referred for catheter ablation of AF who had already received NOAC treatment. NOAC was continued for a minimum of three months after ablation. We assessed procedure-related bleeding or thromboembolic complications, bleeding or thromboembolic complications during a three-month follow-up period and patient-reported adherence to NOAC therapy. The study has not received financial support from external resources. The study was registered with ClinTrials.gov as NCT02569255.


RESULTS
A total of 171 patients were treated with dabigatran (94% 150 mg twice daily), 38 with rivaroxaban (100% 20 mg daily) and 25 with apixaban (100% 5 mg twice daily). NOACs were interrupted for 24 hours before and re-administered two hours after the ablation procedure, without bridging with low molecular weight heparin (LMWH). No periprocedural thromboembolic complications and no bleeding complications were registered except for one pericardial effusion which was percutaneously drained without further complications. No thromboembolic or bleeding complications during follow-up were registered. All patients continued the same NOAC during follow-up as before ablation.


CONCLUSIONS
Anticoagulation with NOAC with a short period of periprocedural interruption without bridging with LMWH seems safe and well-tolerated.


FUNDING
none.


TRIAL REGISTRATION
The trial is registered as ClinTrials.gov no. NCT01569255.