ABC | Volume 110, Nº2, February 2018

Original Article Leiria et al Uninterrupted anticoagulants and flutter ablation Arq Bras Cardiol. 2018; 110(2):151-156 Table 1 – Difference between the populations that received vitamin-K antagonists and the ones who received non-vitamin K antagonists uninterruptedly for atrial flutter ablation Factor NOAC (n = 65) VKA (n = 89) p value Previous history of AF 23 (35.4%) 28 (31.5%) 0.77 Age (years) 58.1 ± 11.7 56.8 ± 14.1 0.55 Gender (male) 45 (69.2%) 63 (70.8%) 0.97 Sinus basal rhythm 33 (50.8%) 28 (31.4%) 0.02 LVEF (%) 59.6 ± 12.3 58.0 ± 16.6 0.57 LA (mm) 44.3 ± 6.2 47.7 ± 7.7 0.01 CHA 2 DS 2 VASc ≥ 2 64.6% 61.8% 0.852 – SAH 59.4% 73.0% 0.07 – DM 20.6% 20.2% 0.95 – Stroke 9.5% 3.4% 0.113 Beta-blockers 55.4% 79.8% 0.002 Calcium channel blockers 10.8% 13.5% 0.79 ACEi/ARB 44.6% 55.1% 0.26 Diuretics 29.2% 41.6% 0.16 Digoxin 12.9% 14.9% 0.90 Statins 27.7% 44.9% 0.04 ASA 15.4% 28.1% 0.09 Antiarrhythmic drugs 55.4% 33.7% 0.01 Previous heart surgery 7.7% 38.6% < 0.001 – Valvar 0.0% 22.7% 0.0001 Ischemic cardiopathy 10.8% 19.3% 0.22 Congenit cardiopathy 9.2% 9.1% 0.79 Myocardiopathy 10.8% 19.3% 0.22 COPD 3.0% 7.9% 0.36 NOAC: non-vitamin K antagonist oral anticoagulants; VKA: vitamin K anticoagulant antagonists; AF: atrial fibrilation; LVEF: left ventricular ejection fraction; LA: left atrium; CHA2DS2VASc: risk for stroke (congestive heart failure, hypertension, age, diabetes, stroke, vascular disease, and female gender); SAH: systemic arterial hypertension; DM: diabete mellitus;ACEi/ARB: angiotensin-converting enzyme inhibitors / angiotensin receptor blocker;ASA: acetylsalicylic acid; COPD: Chronic obstructive pulmonary disease. The p value expresses the difference of the Student’s t test for the continuous variables and the χ 2 in the categorical variables. The statistical significance level adopted was 5%. A third retrospective study of NOACs in this scenario compared patients using apixaban (n = 105), paired with others that used phenprocoumon (n = 210) until hospital discharge. 13 Only the patients submitted to ablation of left atrial arrhythmia were included, unlike our cohort, which only included cases of typical flutter. All patients were using oral anticoagulation for at least four weeks, and the use of anticoagulation was uninterrupted, with use of endovenous heparin during the procedure. There were no thromboembolic events; minor bleedings occurred in 10.5% of the patients using apixaban, and in 12.3% of those using phenprocoumon (p = 0.61). Our cohort demonstrated fewer hemorrhagic complications, however, no procedure carried out approached the left atrium. Proving the variability in the handling of periprocedural anticoagulation of AFL ablation, a study conducted in Europe and in Canada showed that 6% of the centers do not use routine anticoagulation in typical AFL ablation, and that only 31% of the centers performed preprocedural anticoagulation for a minimum period of 4 weeks. 16 Regarding the use of NOACs, only 35% of the centers perform the procedure with the uninterrupted use of medication, and those who suspended the medication demonstrate great variation in the period of the suspension. Table 2 – Type of non-vitamin K antagonist oral anticoagulants and vitamin K anticoagulant antagonists used uninterruptedly for the atrial flutter ablation NOAC (n = 65)% VKA (n = 89)% Rivaroxaban (41) 63.0% Warfarin (77) 86.5% Dabigatran (14) 21.6% Phenprocoumon (12) 13.5% Apixaban (10) 15.4 % NOAC: non-vitamin K antagonist oral anticoagulants; VKA: vitamin K antagonist. 154