Abstract 15824: Safety and Efficacy of Periprocedural Direct Oral Anticoagulant versus Aspirin Use for Reduction of the Risk of Cerebrovascular Events in Patients Undergoing Ventricular Tachycardia Radiofrequency Catheter Ablation (STROKE-VT)

Abstract

Background: The STROKE-VT is an ongoing, multicenter, randomized controlled trial that studies the differences in cerebrovascular events between DOAC vs ASA use post procedurally in ischemic and non-ischemic cardiomyopathy patients undergoing left ventricular tachycardia radiofrequency ablation (VT RFA). Methods: 52 Eligible patients scheduled for VT RFA were randomized 1:1 post procedurally to a DOAC (n=26; Dabigatran-11/Rivaroxaban-12 & Apixaban-3) or ASA (n=26, 81mg) for 30 days. VT ablation was performed under moderate sedation or general anesthesia either through retrograde aortic (n=28) or transseptal (n=24) approach. All patients were given IV heparin for ACT>300msec. Study drug was administered 3 hours after hemostasis. A brain MRI was done within 6-12 hours post VTRFA and at 30 days. NIH stroke scale was used to assess for neurological changes before, after and at 30 day follow up. Results: 52 patients (M:F- 4.2:1) with 55% ICM were enrolled. DOAC group was slightly older (65±8 vs 60±6 yrs, p=0.04)), had longer procedural (186±76 vs 150±51, p<0.001) and RF time (45 ± 23 vs 24±23, p=0.01) and greater use of transseptal approach (58 vs 42%, p=0.03) compared to the ASA group. One patient in the ASA group had a TIA in the immediate postop period. 31% (16/52) had acute asymptomatic cerebral embolizations (ACE) (25% vs 5% with Retrograde aortic approach). DOAC group had a significantly lower incidence of ACE at 1 month f/u MRI (8 vs 38%, p<0.001). On multivariate analysis predictors of acute post VTRFA ACE were retrograde aortic approach, prolonged procedure and RFA time, while delayed ACE was ASA therapy. Two patients died of progressive heart failure with one in each group. 1 patient had a TIA during f/u in the ASA group. Conclusions: DOAC decrease the incidence of delayed ACE after VTRFA. However, retrograde aortic approach and prolonged procedural and RFA time can increase the risk of acute ACE.