One day interruption of NOAC is associated with low risk of periprocedural adverse events during pulmonary vein isolation if combined with left atrial thrombus exclusion with computed tomography

Abstract

Abstract Purpose: Safety, efficacy, and patient comfort are the primary expectations during pulmonary vein isolation (PVI). We aimed to validate the combined advantages of pre-and periprocedural anticoagulation with non-vitamin K anticoagulants (NOACs) and rigorous left atrial appendage thrombus (LAAT) exclusion with computed tomography (CT). Moreover, we assessed the effect of pre-and periprocedural workups and the catheter ablation on the patients' quality of life. Methods: Consecutive patient population was collected between March 2018 and June 2020, who underwent cardiac CT within 24 hours before PVI to plan and guide the ablation and rule out LAAT. NOAC was omitted 24 hours before the ablation. If CT was inconclusive regarding the presence of a thrombus, transoesophageal echocargiography (TOE) was performed. All patients underwent PVI using point-by-point radiofrequency ablation. All patients had a routine follow up at 3 months. Quality of life questionnaires were obtained postprocedurally to evaluate the periprocedural discomfort of the patients. Results: 187 patients (63% male) underwent CT before PVI. TOE was used in 11 (6%) cases. None of the patients experienced stroke during or after the procedure. Based on the quality of life questionnaires, the worst patient discomfort was caused by atrial fibrillation itself, followed by the TOE, then the ablation procedure, hospital stay, and finally the CT. Complication rate was low, with no symptomatic thromboembolic event and 2.1% major bleeding event. Conclusion: Omitting NOAC 24 hours before the ablation might be safe. Moreover, patient comfort may be increased by replacing the TOE examination with CT.