Abed Hany S, Chen Vivien, Kilborn Michael J, Sy Raymond W
Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia; University of Sydney, NSW, Australia.
Department of Haematology, Concord Repatriation General Hospital, Sydney, NSW, Australia; University of Sydney, NSW, Australia.
Heart Lung Circ. 2016 Dec;25(12):1164-1176. doi: 10.1016/j.hlc.2016.04.027. Epub 2016 Jun 21.
Oral anticoagulation (OAC) has been the cornerstone for the prevention of thromboembolic complications in patients with atrial fibrillation (AF) at significant risk of stroke. Catheter ablation is an established efficacious technique for the treatment of AF. Ameliorating the risk of stroke or transient ischaemic attack (TIA) in patients with AF undergoing ablation requires meticulous planning of pharmacotherapy. The advent of non-vitamin K oral anticoagulants (NOACs) has broadened the therapeutic scope, representing a viable alternative to traditional vitamin K antagonists (VKA) in non-valvular AF. Potential advantages of NOACs include greater pharmacokinetic predictability, at least comparable efficacy as compared to VKA and a superior haemorrhagic complication profile. However, robust evidence for the safety and efficacy of periprocedural NOAC use for AF ablation remains uncertain with a non-uniform clinical approach between and within institutions. The following review will summarise the current and emerging evidence on periprocedural management of NOACs in patients undergoing catheter ablation of AF. An overview of NOAC pharmacology will provide a foundation for the review of reversal agents in the context of catheter ablation of AF. The purpose of the review is to outline key studies and identify key areas for further critical research with the ultimate aim of developing evidence-based guidelines for optimal care.
口服抗凝治疗（OAC）一直是预防具有显著卒中风险的心房颤动（AF）患者血栓栓塞并发症的基石。导管消融是一种成熟的治疗AF的有效技术。改善接受消融治疗的AF患者的卒中或短暂性脑缺血发作（TIA）风险需要精心规划药物治疗。非维生素K口服抗凝剂（NOACs）的出现拓宽了治疗范围，在非瓣膜性AF中是传统维生素K拮抗剂（VKA）的一种可行替代方案。NOACs的潜在优势包括更高的药代动力学可预测性、与VKA相比至少相当的疗效以及更好的出血并发症情况。然而，关于围手术期使用NOACs进行AF消融的安全性和有效性的有力证据仍然不确定，各机构之间以及机构内部的临床方法并不统一。以下综述将总结目前关于接受AF导管消融患者围手术期NOACs管理的现有和新出现的证据。对NOAC药理学的概述将为在AF导管消融背景下审查逆转剂提供基础。该综述的目的是概述关键研究并确定进一步关键研究的关键领域，最终目标是制定基于证据的最佳护理指南。
