Safety of uninterrupted vs. minimally interrupted oral anticoagulation in left atrial catheter ablation
A Ferencz, D Simon, K Janosi, D Debreceni, D Torma, B Bocz, P KupoAbstract
Introduction
Optimal periprocedural management of oral anticoagulation during left atrial catheter ablation is crucial to minimize thromboembolic and bleeding complications. While both uninterrupted (UI) and minimally interrupted (MI) anticoagulation strategies are widely used, variations in protocols and patient populations leave the optimal approach uncertain.
Methods
In this prospective observational study, we enrolled consecutive patients undergoing left atrial catheter ablation (for atrial fibrillation or atypical left atrial flutter) between July 1, 2022, and March 1, 2025, who were receiving non–vitamin K antagonist oral anticoagulants (NOACs). Patients were treated according to either a UI or MI anticoagulation protocol. The primary endpoint was the incidence of procedure-related complications.
Results
A total of 939 patients were included (MI: n=414; UI: n=525). The overall complication rate was 1.38% (n=13), with no significant difference between the MI and UI groups (5 vs. 8; p=0.681). Lower body weight (OR=0.96, p=0.021) and body mass index (BMI; OR=0.88, p=0.025) were independently associated with higher complication risk, while height showed no effect. Age, sex, anticoagulation strategy (UI vs. MI), type of NOAC, energy source, procedure duration, and intraoperative heparin dose were not significantly associated with complications (all p>0.05).
Conclusion
Uninterrupted oral anticoagulation with NOACs during left atrial ablation is safe and provides comparable outcomes to a minimally interrupted approach.