96-13: Non-vitamin K Antagonist Oral Anticoagulant and Warfarin as Periprocedural Oral Anticoagulation Therapy of Catheter Ablation for Atrial Fibrillation: J-CARAF Study

Abstract

Purpose and Method: Japanese Heart Rhythm Society requested electrophysiology (EP) centers to register the data of patients who underwent catheter ablation for atrial fibrillation (AF), Japanese Cather Ablation Registry of AF [J-CARAF]. We assessed how the periprocedural use of a NOAC (non-vitamin K antagonist oral anticoagulant) was associated with the incidence of bleeding and stroke events. Result(s): Two hundred and four EP centers reported the data of 4698 AF ablation cases (63.2 + 10.6 year old, male; 74.0%, paroxysmal AF; 64.2%). As a periprocedural OAC, warfarin and NOACs were given in 2568 (54.7%) and in 2130 subjects (dabiagtran 1027 [21.9%], rivaroxaban 606 [12.9%], and apixaban 497 [10.6%]), respectively. Ischemic stroke and bleeding complications such as pericardial effusion occurred in three and 100 patients, respectively (2.2%). No inter-OAC differences in the incidence of complications were detected (2.6 %, 1.5%, 2.3%, 1.2%: above mentioned order). Dabigatran was given in significantly younger subjects with lower CHA2DS2-VASc scores (warfarin vs. dabigatran = 1.95 + 1.48 vs. 1.59 + 1.35, p , 0.05). Multivariate logistic regression analysis did not reveal the influence of any NOAC on adverse events. Only chronic hemodialysis seemed to have increased the number of events (p = 0.003, odds ratio 4.30 [1.62-11.38]). However, when three NOACs were collectively analyzed, they were barely associated with the lower incidence of complications (p , 0.05, OR 0.65 [0.42-0.99]). Conclusion(s): These results suggest that NOACs when used as a periprocedural OAC of AF ablation do not increase the incidence of ischemic stroke or bleeding events.