Results

One hundred thirty-seven patients (mean age 55.0±13.4, 29.1% female) underwent 230 catheter ablations for AF (1.7±1.0 per patient). A total of 55 patients (39.4%) underwent 70 procedures (30.4%) on NOAC, the remaining were ablated while on VKAs. Warfarin (97.6%) and rivaroxaban (56.4%) were the most frequently used agents in the respective groups. VKA interruption regimen with low-molecular weight heparin bridging was adopted in 56 catheter ablations (35%). NOAC use was uninterrupted pre-procedure in all patients but one (no heparin bridging was performed either). Pre-procedural TOE was performed for 40 and 125 ablations in the NOAC and VKA group (57.1% vs. 78.1%, respectively; p<0.001); 3 procedures in the VKA group were deferred due to the presence of intracardiac thrombus (p=0.55), despite at least two INR measurements >2 in the 4 weeks pre ablation. Most patients had paroxysmal AF (57.5%) at baseline, and mean AF duration was 3.3±3.1 years. Mean CHA2DS2VASc and HAS-BLED score were 1.5±1.5 and 0.8±0.9, respectively. As many as 10.4% had a history of stroke or TIA, and 3.6% was on concomitant single antiplatelet therapy. Mean left atrial diameter was 47±7mm.
Some differences were found at baseline population between the two groups: left ventricular ejection fraction, wall thickness and outflow tract gradient were higher in subjects on NOAC; patients on VKA more frequently presented with persistent AF or had history of previous surgical myectomy. Detailed baseline characteristics are reported in Table 1.