Kumar Narendra, Elbanhawy Noha, Choudhury Moinuddin, Potluri Rahul, Chalil Shajil, Abozguia Khalid
Cardiology Department, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Trust, Blackpool, UK, FY3 8NR.
Department of Cardiology, Bedford Hospital, Bedfordshire Hospitals NHS Foundation trust, Bedford, UK.
J Atr Fibrillation. 2021 Aug 31;14(2):20200445. doi: 10.4022/jafib.20200445. eCollection 2021 Aug.
Catheter ablation in patients with atrial fibrillation (AF)/atrial flutter carries a risk of thromboembolism and major bleeding. In light of recent prospective trial data on the safety and efficacy of uninterrupted edoxaban in patients undergoing AF/flutter ablation, real-world Data was aimed for validation.
A total of 228 patients who underwent AF/atrial flutter ablation over 14 months at our centre were retrospectively analyzed. All patients received uninterrupted oral anticoagulation for at least 4 weeks prior to ablation and 3 months post-ablation. Both bleeding and thromboembolic events were assessed at 24 hours comparing patients on warfarin, rivaroxaban and edoxaban.
Mean age of patients were 68.5 +/- 8 years in the warfarin group ( N =86), 63.4 +/- 10.6 years; in the edoxaban group ( N =63) and 62.3 +/- 11.6 years in the rivaroxaban group ( N =79). CHADSVASc scores were 2.43 +/- 1.34, 1.68 +/- 1.34 and 1.64 +/- 1.38 respectively. The mean left atrial sizes were 42.7 +/- 6.8 mm, 42.0 +/- 6 mm and 41.1 +/- 6.5 mm respectively. The study endpoint was death, acute thromboembolism or major bleeding. There was 1 pericardial effusion (1.2%) in the warfarin group, 1 pericardial effusion and 1 transient ischaemic attack (2.5%) in the rivaroxaban group and 1 pericardial effusion needing drainage (1.6%) in the edoxaban group. There were no significant differences in the study endpoints between groups.
This real-world study demonstrated no significant difference in safety and efficacy between uninterrupted edoxaban, warfarin and rivaroxaban in patients undergoing AF/flutter ablation.
心房颤动（AF）/心房扑动患者进行导管消融存在血栓栓塞和大出血风险。鉴于近期关于不间断服用依度沙班对接受AF/扑动消融患者安全性和有效性的前瞻性试验数据，本研究旨在进行真实世界数据验证。
回顾性分析了在我们中心14个月内接受AF/心房扑动消融的228例患者。所有患者在消融前至少4周和消融后3个月接受不间断口服抗凝治疗。在24小时时比较服用华法林、利伐沙班和依度沙班的患者的出血和血栓栓塞事件。
华法林组患者的平均年龄为68.5±8岁（N = 86），依度沙班组为63.4±10.6岁（N = 63），利伐沙班组为62.3±11.6岁（N = 79）。CHADSVASc评分分别为2.43±1.34、1.68±1.34和1.64±1.38。平均左心房大小分别为42.7±6.8mm、42.0±6mm和41.1±6.5mm。研究终点为死亡、急性血栓栓塞或大出血。华法林组有1例心包积液（1.2%），利伐沙班组有1例心包积液和1例短暂性脑缺血发作（2.5%），依度沙班组有1例需要引流的心包积液（1.6%）。各组之间的研究终点无显著差异。
这项真实世界研究表明，在接受AF/扑动消融的患者中，不间断服用依度沙班、华法林和利伐沙班在安全性和有效性方面无显著差异。
