ABSTRACT
AIMS: This prospective, randomized, single-centre study aimed to directly compare the safety and efficacy of uninterrupted and interrupted periprocedural anticoagulation protocols with direct oral anticoagulants (DOACs) in patients undergoing catheter ablation of non-valvular atrial fibrillation (NVAF). METHODS AND RESULTS: We randomly assigned 846 NVAF patients receiving DOACs prior to ablation to uninterruption (n = 422) or interruption (n = 424) of the DOACs on the day of the procedure. The primary endpoint was a composite of symptomatic thromboembolisms and major bleeding events within 30 days after the ablation. Secondary endpoints included symptomatic and silent thromboembolisms and major and minor bleeding events. The primary endpoint occurred in 0.7% of the uninterrupted DOAC group [1 transient ischaemic attack (TIA) and 2 major bleeding events] and 1.2% of the interrupted DOAC group (1 TIA and 4 major bleeding events) (P = 0.480). The incidence of major and minor bleeding was comparable between the two groups (0.5% vs. 0.9%, P = 0.345; 5.9% vs. 5.4%, P = 0.753). Silent cerebral ischaemic lesions (SCILs) were observed in 138 (20.9%) of the 661 patients undergoing post-ablation magnetic resonance (MR) imaging. The uninterrupted and interrupted DOAC groups revealed a similar incidence of SCILs (19.8% vs. 22.0%, P = 0.484) and percentage of SCILs with disappearance on follow-up MR imaging (77.8% vs. 82.1%, P = 0.428). CONCLUSION: Both the uninterrupted and interrupted DOAC protocols revealed a low risk of symptomatic thromboembolisms and major bleeding events and similar incidence of SCILs and minor bleeding events and may be feasible for periprocedural anticoagulation in NVAF patients undergoing catheter ablation.
Subject(s)
Antithrombins/administration & dosage , Atrial Fibrillation/surgery , Catheter Ablation , Ischemic Attack, Transient/prevention & control , Thromboembolism/prevention & control , Administration, Oral , Aged , Antithrombins/adverse effects , Atrial Fibrillation/complications , Atrial Fibrillation/diagnosis , Atrial Fibrillation/physiopathology , Catheter Ablation/adverse effects , Drug Administration Schedule , Factor Xa Inhibitors/administration & dosage , Female , Hemorrhage/chemically induced , Humans , Ischemic Attack, Transient/diagnostic imaging , Ischemic Attack, Transient/etiology , Japan , Male , Middle Aged , Prospective Studies , Risk Factors , Thromboembolism/diagnostic imaging , Thromboembolism/etiology , Time Factors , Treatment OutcomeABSTRACT
We describe a case of a 10-year-old girl with genetically confirmed LQTS type 3 developed recurrent episodes of loss of consciousness due to epilepsy that was diagnosed by using an implantable loop recorder (ILR).
