Aims/Objectives:

Patients with bleeding disorders are a rare and may be challenging in catheter ablation (CA) procedures. The most common types of bleeding disorders are von Willebrand disease (VWD) and hemophilia A (HA). These patients tend to have an increased risk of bleeding complications compared to the normal population. There is a lack of data concerning peri- and postinterventional coagulation treatment. We sought to assess the optimal clotting management of patients with VWD and HA referred to catheter ablation procedures. 

Methods and Results: 

In this observational study we analyzed patients with VWD or HA undergoing CA procedures. Data was acquired between 2016 and 2021 at the University Heart Center of Lübeck. Clotting factors were administered based on hemostaseological recommendations. CA was performed according to the local protocol. Unfractionated heparine was administered intravenously during the procedure  based on activated clotting time (ACT). Primary endpoints included feasibility of the procedure, bleeding complications and periprocedural thrombembolic events. Secondary endpoints included bleeding complications and thromboembolic events up to one year after catheter ablation.  A total of  6 patients (3 with VWD Type I, one with VWD Type IIa, two with HA) underwent 9 catheter ablation procedures (Pulmonary vein isolation (PVI): 2x radiofrequency (RF), 1x laserballoon (LB), 1x cryoballoon (CB); PVI + cavotricuspid isthmus (CTI): 1x RF; PVI + LAA-Isolation: 1x RF; Premature ventricular contraction (PVC): 2x RF; AV-nodal reentrant tachycardia (AVNRT): 1x RF). VWD patients received intravenous administration of 2.000 – 3.000 IE of WILATE (Factor VIII and von Willebrand Factor) 30 to 45 minutes before ablation. Patients with HA received 2.000 IE Factor VIII before the procedure. One patient with VWD Type IIa received 2.000 IE Haemoctin. All patients received unfractioned heparine (cumulative dose of 9.000 – 18.000 IE) periprocedural aiming a target ACT of > 300 s. Oral anticoagulation was prescribed in all pulmonary vein isolation cases 12 h after ablation. One patient was treated with ASS for 4 weeks after CA of PVCs. No oral anticoagulation was prescribed after slow pathway modulation on a patient with AVNRT. In this complex patient population no bleeding complications or thromboembolic events were reported during follow up. 

Conclusions:

Catheter ablation in patients with VWD and HA seems to be feasible and safe. Administration of clotting factors based on to the blood serum levels before the procedure was crucial for an optimal coagulation management.