Background

Data regarding uninterrupted oral anticoagulation use in patients with chronic kidney disease (CKD) during catheter ablation for left atrial arrhythmias is limited. The present study aimed to evaluate the safety and efficacy of periprocedural uninterrupted direct oral anticoagulant (DOAC) use compared with uninterrupted phenprocoumon use in patients with CKD undergoing left atrial catheter ablation.

Methods and Results

We conducted a retrospective single-center study of patients who underwent left atrial catheter ablation between 2016 and 2018 with underlying chronic kidney disease (glomerular filtration rate (GFR) between 15-45 ml/min).

The primary objective of this study was to investigate whether direct oral anticoagulant (DOAC) therapy or phenprocoumon presents a superior safety profile in patients with chronic kidney disease (CKD) undergoing left atrial catheter ablation. We compared periprocedural complications (arteriovenous fistula, aneurysm, significant hematoma (> 5 cm)) and/or bleeding (drop in hemoglobin of >2 g/dl, pericardial effusion, retroperitoneal bleeding, other bleeding, stroke) between patients receiving either uninterrupted DOAC or warfarin therapy.  Secondary analysis included patient baseline characteristics as well as procedural data. 188 patients (female n=108 (57%), mean age 75.3 ± 8.1 years, mean GFR 36.8 ±6 ml/min) were included in this study. Underlying arrhythmias were atrial fibrillation (n=104, 55.3%) and atypical atrial flutter (n=84, 44.7%).
Of these, 132 patients (70%) were under a DOAC medication, and 56 (30%) were under phenprocoumon.

Groin complications including pseudoaneurysm and/or AV fistula occurred in 8,9% of patients in the phenprocoumon group vs. 11,3% of patients in the DOAC group, which was not statistically significant (p=0,62). Incidence of cardiac tamponade, small pericardial effusions, and bleeding were low in both groups with no significant differences.

We found a similar mean drop in the postprocedural hemoglobin levels in both groups (1.1 ± 0.9 mg/dL in the phenprocoumon group vs. 1.1 ± 1 mg/dL in the DOAC group, p = 0.714).There were no reported incidents of stroke in either group.

Conclusion

The type of anticoagulation had no significant influence on bleeding or thromboembolic events as well as groin complications in this retrospective study. Despite observing an increased rate of groin complications, the uninterrupted use of DOAC or phenprocoumon
during left atrial catheter ablation in patients with CKD appears to be feasible and effective.