Periprocedural and long term safety and feasibility of treatment with novel oral anticoagulants in patients with biological valve and atrial fibrillation

Background: In patients with biological valve and atrial fibrillation (AF) it is unclear whether treatment with novel oral anticoagulants (NOAC) is safe and effective. We report the safety and feasibility of periprocedural and long term treatment with NOAC in patients with biological valve and AF. Methods: 127 consecutive patients with a biological valve undergoing AF ablation at different institutions have been enrolled in this study. All patients were anticoagulated for at least 4 weeks prior to ablation with either rivaroxaban or apixaban which were continued for at least a year after the procedure. All patients underwent the ablation with an uninterrupted anticoagulation strategy. All patients underwent pulmonary vein antrum, posterior wall and non pv trigger ablation as disclosed by isoproterenol challenge test. These patients were matched by age and gender with an equal number of patients (n=127) with biological valve undergoing AF ablation on uninterrupted warfarin. A subset of 24 pts underwent post procedure diffused magnetic resonance (dMRI) to detect silent cerebral ischemia (SCI). results: The majority of patients had aortic valve replacement (75, 59%), while mitral valve was replaced in 52(41%) pts, which did not differ from control [73(57%), 54(43%); aortic (p=0.8) and mitral valve (p=0.8) respectively]. Mean age of the study population was 63.0 ± 10.9 with 66% being male. Baseline characteristics were similar between NOAC and control group. Majority of the patients had non- paroxysmal AF [(86(68%) NOAC and 88(69%) control, p=0.8]. The CHADS2 Score was ≥ 2 in 90 (71.0%) NOAC and 86(68%) control (p=0.6) patients. Predominantly pts underwent ablation with uninterrupted rivaroxaban [89(70%)], while the remaining 38 pts (30%) underwent the ablation while on apixaban. Only 2 groin hematoma were observed periprocedurally in both groups. No stroke/TIA was observed both periprocedurally and at long term follow-up. No post procedure SCI was detected by dMRI. Conclusion: Periprocedural and long term administration of NOACs in patients with biological valve and AF appear as safe as warfarin therapy.