Non-vitamin K Oral Anticoagulants in Hypertrophic Cardiomyopathy
Patients Undergoing Catheter Ablation of Atrial Fibrillation
Abstract
Introduction: Patients with hypertrophic cardiomyopathy (HCM) and atrial
fibrillation (AF) require chronic anticoagulation due to a high
thromboembolic risk. Evidence supporting use of non-vitamin K oral
anticoagulants (NOACs) in patients with HCM remains sparse, and there
are no data regarding the use of NOACs in HCM patients undergoing
catheter ablation of AF. Methods: Observational non-randomised study in
4 European Centres. We aimed to investigate the safety and efficacy of
NOACs compared with vitamin-K antagonists (VKAs) in patients with HCM
undergoing catheter ablation for AF. Results: One hundred thirty-seven
HCM patients (mean age 55.0±13.4, 29.1% female) underwent 230 catheter
ablations for AF (1.7±1.0 per patient). A total of 55 patients (39.4%)
underwent 70 procedures (30.4%) on NOAC, while the remaining were on
VKA. Warfarin (97.6%) and rivaroxaban (56.4%) were the most frequently
used agents in the respective groups. No procedure-related deaths were
reported. We observed no significant difference in the rate of
thromboembolism (VKA 0.6%; NOAC 0%; p=1.0) or minor bleeding (VKA
0.6%; NOAC 1.4%; p=0.54). There was a non-significant trend towards a
lower incidence of major bleeding (VKA 6.8%; NOAC 1.4%; p=0.09).
Conclusion: These preliminary data suggest that NOACs are at least as
safe and effective as VKAs in patients with HCM undergoing catheter
ablation for AF.