Safety of uninterrupted direct oral anticoagulation strategy for pulmonary vein isolation using second generation cryoballoon

Abstract

Some anticoagulation strategies have been reported to reduce thromboembolic and hemorrhagic complications during the perioperative period of pulmonary vein isolation (PVI). Reporting our 5 years experience of uninterrupted oral anticoagulation strategy during PVI using second generation cryoballoon. From June 2012 to May 2017, all consecutive patients undergoing PVI using Artic Front Advance cryoballoon were enrolled. Both direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) were uninterrupted. Transseptal puncture was performed under transesophagal echographic guidance. Femoral veinous access was closed using “figure of eight” skin suture technique. All patients had transthoracic echocardiography and chest X-ray the day after the procedure and were discharged after a 48 hours monitoring period. Complications were prospectively collected up until a 4 months follow-up visit. In total, 327 patients [mean age 58 ± 11 years old; 239 males (73,1%)] underwent PVI using cryoballoon for paroxysmal (301 patients; 91,4%) or persistent (26 patients; 8,6%) atrial fibrillation. In 45 patients (13,8%), PVI was combined with radiofrequency cavotricuspid isthmus ablation. The mean procedure duration was 81 ± 27 min. DOACs were predominantly used (71,7%): dabigatran in 35 patients (10,7%), rivaroxaban in 140 patients (42.8%), and apixaban in 59 patients (18.2%). Complications were observed in 7% of cases ( Table 1 ). No thromboembolic events were reported. Pericardial effusions were less frequent in the DOACs group as compared to the VKAs group. Uninterrupted direct oral anticoagulation seems to be a safe strategy for PVI using second generation cryoballoon in daily practice.