Real-life safety of atrial flutter ablation in the era of NOACs. The French Global Flutter Study

Abstract

Cavotricuspid isthmus (CTI) radiofrequency ablation (RFA) is considered a first-line therapy to achieve rhythm control in patients with typical atrial flutter (AFL). Determine the incidence and risk factors for developing bleeding complications in patients takingnon-vitamin K anticoagulants (NOAC) versus vitamin K antagonists (VKA) and undergoing an atrial flutter catheter ablation in everyday clinical practice. It is a multicenter, observational, prospective study of patients with AFL undergoing a CTI RFA. Eligible patients had been taking apixaban (2.5 or 5 mg twice daily), rivaroxaban (15 or 20 mg once daily), dabigatran (110 or 150 twice daily) or VKA for ≥ 3 weeks before the procedure, and were followed for 30 days afterwards. A total of 477 patients, 69,7 ± 10.9 [interquartile range 29, 96] years, 80% male, mean CHA2DS2-VASc score 2.4 ± 1.5 were enrolled at 25 academic/nonacademic centres in France. 84 patients (17.6%) were receiving rivaroxaban (68 patients on 20 mg/day, and 16 patients on 15 mg/day). 89 (18.6%) patients were receiving dabigatran 65 patients on 300 mg/day and 24 on 220 mg/day. 244 (51.15%) patients were receiving apixaban (210 on 10 mg/day, and 34 patients on 5 mg/day). 60 (12.57) patients were receiving VKA. The mean INR before procedure was 2.7 ± 1.8. The most prevalent concomitant disorders were hypertension (53%), diabetes (20%) and vascular disease 87 (18%). Mean creatinine concentration was 98 ± 45micromol/L, median weight was 84 ± 18 kg and mean creatinine clearance (Cockcroft-Gault) was 80 ± 33 mL/min. Overall, 28 patients were switched to unfractionated heparin or enoxaparin. The median duration of switch was 6 ± 14 hours. Complications were reported at 30 days, and included only 1 (1.6%) bleeding event in patient receiving VKA (hematoma). Every day practice of AFL ablation in patients receiving NOACs is safe. No complications were reported in these patients on NOACs.