PO-01-160 POST-PROCEDURE ANTICOAGULATION IN PATIENTS RECEIVING PULMONARY VEIN ISOLATION WITH LEFT ATRIAL APPENDAGE OCCLUSION DEVICES: A SINGLE CENTER RETROSPECTIVE COHORT STUDY

Abstract

Embolic events are a major complication of atrial fibrillation (AF). To prevent these events systemic anticoagulation is given based on an individual’s calculated risk using validated scoring systems (e.g., CHA2DS2-VASC score). In individuals for whom long-term oral anticoagulation (OAC) is not possible, placement of left atrial appendage occlusion (LAAO) devices is a reasonable alternative. Occasionally, individuals with prior LAAO device implantation undergo pulmonary vein isolation (PVI) for rhythm control, which typically warrants a short-term period of at least 6 weeks of systemic OAC post-PVI. It is not clear, however, whether prior placement of a LAAO device negates the need for 6 weeks of OAC. To determine the impact of truncated OAC duration the first 6 weeks post-PVI compared to those completing 6 weeks of OAC in individuals with high bleeding risk and prior placement of a LAAO device. We retrospectively examined patients 665 patients from Rush University Medical Center that received pulmonary vein isolation from March 2017 to December 2021. Of these patients, 18 had successful implantation of a LAAO device prior to PVI. Nine patients completed a 6-week course of OAC and 9 patients completed < 6 weeks of OAC after ablation. The primary clinical outcome was the incidence of thromboembolic events during the peri-and post-procedural period. Secondary outcome was the incidence of major or minor bleeding events while on OAC using standard definitions. The median age was 65 years. Fifty-five percent of patients in each arm were diagnosed with persistent atrial fibrillation. Mean CHA2DS2-VASc was 3 and mean HAS-BLED score was 2.8. Reasons for shorter course of OAC in the truncated group were variable and based on shared decision making between the provider and the patient. There were no thromboembolic events post-PVI in either group. Two patients (29%) who received 6 weeks of OAC had bleeding events with no bleeding events in the group who received truncated duration of OAC post-PVI. In this small proof of concept study, patients with prior LAAO device placement who underwent subsequent PVI and received < 6 weeks of OAC during the post-PVI period did not have an increased rate of thromboembolic events compared to those who received 6 weeks of OAC. Conversely, bleeding events occurred more frequently in LAAO patients who received the full 6 weeks of OAC post-PVI. Larger prospective or randomized clinical trials are needed to validate these findings.Tabled 1Patient, Watchman & Pulmonary Vein Isolation CharacteristicsSix Weeks Post-PVILess than Six Weeks Post-PVICo-morbiditiesTachycardia Mediated Cardiomyopathy (%)2 (22.2)2 (22.2)Hypertension (%)8 (88.9)9 (100)Diabetes Mellitus (%)1 (11.1)5 (55.6)Ischemic Stroke/TIA (%)2 (22.2)2 (22.2)Coronary Artery Disease (%)3 (33.3)2 (22.2)Peripheral Vascular Disease (%)01 (11.1)Thrombocytopenia (%)1 (11.1)2 (22.2)Chronic Kidney Disease (%)2 (22.2)3 (33.3)History of GI Bleeds (%)5 (55.6)4 (44.4)Watchman IndicationsHistory of Bleeding (%)5 (55.6)5 (55.6)High Risk of Bleeding (%)3 (33.3)3 (33.3)High Risk Employment (%)01 (11.1)Drug Interaction (%)1 (11.1)0Pulmonary Vein IsolationAnticoagulation prior to PVI (%)6 (66.7)5 (55.6)TEE prior to PVI (%)5 (55.6)5 (55.6)PVI Modality & ProcedureCryo-balloon ablation (%)3 (33.3)3 (33.3)Radio-Frequency Ablation (%)4 (44.4)2 (22.2)Laser Balloon Ablation (%)2 (22.2)4 (44.4)Cardioversion During PVI (%)4 (44.4)5 (55.6)Concomitant Atrial Flutter Ablation (%)8 (88.9)4 (44.4) Open table in a new tab