title: Comparison of safety of left atrial catheter ablation procedures for atrial arrhythmias under continuous anticoagulation with apixaban versus phenprocoumon.
abstract: Apixaban is increasingly used for stroke prevention in patients with atrial fibrillation. Data about the safety of left atrial radiofrequency ablation procedures under continuous apixaban therapy are lacking. We performed a matched-cohort study of patients undergoing left atrium ablation procedures for atrial fibrillation or left atrial flutter. For each patient on apixaban, 2 patients on phenprocoumon were matched by age, gender, and type of arrhythmia. The primary safety end point was a composite of bleeding, thromboembolic events, and death. We identified 105 consecutive patients (35 women; mean age 63 years) on apixaban and matched 210 phenprocoumon patients (70 women, mean age 64 years). The primary end point was met in 11 patients of the apixaban group and 26 patients of the phenprocoumon group (10.5% vs 12.3%, p = 0.71). Major bleeding complications occurred in 1 patient of the apixaban group and 1 patient of the phenprocoumon group (1% vs 0.5%, p >0.99). Minor bleeding complications were observed in 10 patients of the apixaban group and 25 patients of the phenprocoumon group (9.5% vs 11.9%, p = 0.61). No patient in either group experienced a thromboembolic event and no patient died. In patients on apixaban, no clinical variable was predictive for bleeding complications. Left atrial ablation procedures under continuous oral anticoagulation with apixaban are feasible and as safe as under continuous oral anticoagulation with phenprocoumon.
authors.affiliation: German Heart Center Munich, Technical University, Munich, Germany. Electronic address: bernhard_kaess@gmx.de.
authors.forename: Bernhard M
authors.initials: BM
authors.lastname: Kaess
authors.affiliation: German Heart Center Munich, Technical University, Munich, Germany.
authors.forename: Sonia
authors.initials: S
authors.lastname: Ammar
authors.affiliation: German Heart Center Munich, Technical University, Munich, Germany.
authors.forename: Tilko
authors.initials: T
authors.lastname: Reents
authors.affiliation: German Heart Center Munich, Technical University, Munich, Germany; Department for Cardiology, Stadtspital Triemli, Zurich, Switzerland.
authors.forename: Roger
authors.initials: R
authors.lastname: Dillier
authors.affiliation: German Heart Center Munich, Technical University, Munich, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Lennerz
authors.affiliation: German Heart Center Munich, Technical University, Munich, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Semmler
authors.affiliation: German Heart Center Munich, Technical University, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Grebmer
authors.affiliation: German Heart Center Munich, Technical University, Munich, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Bourier
authors.affiliation: German Heart Center Munich, Technical University, Munich, Germany.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Buiatti
authors.affiliation: German Heart Center Munich, Technical University, Munich, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Kolb
authors.affiliation: German Heart Center Munich, Technical University, Munich, Germany.
authors.forename: Isabel
authors.initials: I
authors.lastname: Deisenhofer
authors.affiliation: German Heart Center Munich, Technical University, Munich, Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Hessling
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D065427:Factor Xa Inhibitors / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010644:Phenprocoumon / Q000008:administration & dosage*; D011720:Pyrazoles / Q000008:administration & dosage*; D011728:Pyridones / Q000008:administration & dosage*; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013923:Thromboembolism / Q000150:complications / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D010644:Phenprocoumon