Intraprocedural anticoagulation dynamics in pulsed field versus radiofrequency ablation: impact of method and anticoagulation type
A Mpatsouli, A Megarisiotou, S Xydonas, G Papingiotis, S Ziogou, E Konstantinidou, B Parasxi, A TrikasAbstract
Background/Introduction
Periprocedural anticoagulant management is essential to reduce the risk of thromboembolism and bleeding during atrial fibrillation (AF) catheter ablation. Activated Clotting Time (ACT) is a critical parameter used to monitor anticoagulation during AF ablation. Pulsed Field Ablation (PFA) is a novel, promising method for AF ablation. Although, optimal intraprocedural anticoagulation strategies for PFA, particularly for patients on various Direct Oral Anticoagulants (DOACs), remain less defined compared to Radiofrequency (RF) protocols.
Purpose
We sought to compare intraprocedural heparin requirements and ACT dynamics between PFA and RF ablation and to evaluate the specific impact of baseline DOAC type (Apixaban, Rivaroxaban, and Dabigatran) on anticoagulation levels.
Methods
91 consecutive patients who underwent AF catheter ablation for paroxysmal or persistent AF were included in the study. All patients received uninterrupted DOAC preoperatively and they were divided in distinct groups depending on whether they received dabigatran, rivaroxaban or apixaban. In the PFA group ablation was performed via Affera™ and FARAPULSE™ PFA systems. In the RF group ablation was performed via THERMOCOOL SMARTTOUCH® SF Catheter. ACT levels were measured at 30 minutes after the onset of the procedure, during, and post-procedurally at standardized intervals.
Results
In a cohort of 91 patients, PFA (n=34) required significantly less total heparin than RF (n=57) (10,014 ± 2,436 vs. 14,933 ± 4,597 IU; p<0.001), attributable to the abbreviated procedural duration. Longitudinal analysis (Figure 1) revealed that PFA patients began with a significantly higher 30min - ACT (293 ± 69s vs. 261 ± 51s; p=0.043) and exhibited distinct time-course trends compared to the gradual ACT elevation seen in RF. Furthermore, Figure 2 demonstrates significant variability by anticoagulant type: Apixaban patients showed the lowest mean baseline ACT (253 ± 56s), Rivaroxaban intermediate (275 ± 69s), while Dabigatran (290 ± 61s) presented the highest baseline.
Conclusions
PFA is associated with reduced heparin requirements and distinct ACT dynamics compared to RF. Significant 30-min variations by DOAC type suggest that standard ACT targets may need refinement for PFA and specific Factor Xa inhibitors to avoid over-anticoagulation and possible complications.Figure 1For image description, please refer to the figure legend and surrounding text.Figure 2For image description, please refer to the figure legend and surrounding text.