PMID- 36498531
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230308
IS  - 2077-0383 (Print)
IS  - 2077-0383 (Electronic)
IS  - 2077-0383 (Linking)
VI  - 11
IP  - 23
DP  - 2022 Nov 25
TI  - Safety and Feasibility of Catheter Ablation Procedures in Patients with Bleeding 
      Disorders.
LID - 10.3390/jcm11236956 [doi]
LID - 6956
AB  - Aims/Objectives: Patients with bleeding disorders are a rare and complex 
      population in catheter ablation (CA) procedures. The most common types of 
      bleeding disorders are von Willebrand disease (VWD) and hemophilia A (HA). 
      Patients with VWD or HA tend to have a higher risk of bleeding complications 
      compared to other patients. There is a lack of data concerning peri- and 
      postinterventional coagulation treatment. We sought to assess the optimal 
      management of patients with VWD and HA referred for catheter ablation procedures. 
      Methods and Results: In this study, we analyzed patients with VWD or HA 
      undergoing CA procedures at two centers in Germany and Switzerland between 2016 
      and 2021. Clotting factors were administered in conjunction with 
      hemostaseological recommendations. CA was performed as per the institutional 
      standard. During the procedure, unfractionated heparin (UFH) was given 
      intravenously with respect to the activated clotting time (ACT). Primary 
      endpoints included the feasibility of the procedure, bleeding complications, and 
      thromboembolic events during the procedure. Secondary endpoints included bleeding 
      complications and thromboembolic events up to one year after catheter ablation. A 
      total of seven patients (three VWD Type I, one VWD Type IIa, three HA) underwent 
      10 catheter ablation procedures (pulmonary vein isolation (PVI): two x 
      radiofrequency (RF), one x laser balloon (LB), one x cryoballoon (CB); PVI + 
      cavotricuspid isthmus (CTI): one x RF; PVI + left atrial appendage isolation 
      (LAAI): one x RF; Premature ventricular contraction (PVC): three x RF; 
      Atrioventricular nodal reentrant tachycardia (AVNRT): one x RF). VWD patients 
      received 2000-3000 IE Wilate i.v. 30 to 45 min prior to ablation. Patients with 
      HA received 2000-3000 IE factor VIII before the procedure. All patients 
      undergoing PVI received UFH (cumulative dose 9000-18,000 IE) with a target ACT of 
      >300 s. All patients after PVI were started on oral anticoagulation (OAC) 12 h 
      after ablation. Two patients received aspirin (acetylsalicylic acid; ASA) for 4 
      weeks after the ablation of left-sided PVCs. No anticoagulation was prescribed 
      after slow pathway modulation in a case with AVNRT. No bleeding complications or 
      thromboembolic events were reported. During a follow-up of one year, one case of 
      gastrointestinal bleeding occurred following OAC withdrawal after LAA occlusion. 
      Conclusions: After the substitution of clotting factors, catheter ablation in 
      patients with VWD and HA seems to be safe and feasible.
FAU - Feher, Marcel
AU  - Feher M
AD  - Department of Rhythmology, University Heart Center Lubeck, University Hospital 
      Schleswig-Holstein, 24105 Kiel, Germany.
FAU - Saguner, Ardan M
AU  - Saguner AM
AD  - Department of Cardiology, Universitatsspital Zurich, 8091 Zurich, Switzerland.
FAU - Kirstein, Bettina
AU  - Kirstein B
AUID- ORCID: 0000-0002-6881-871X
AD  - Department of Rhythmology, University Heart Center Lubeck, University Hospital 
      Schleswig-Holstein, 24105 Kiel, Germany.
FAU - Vogler, Julia
AU  - Vogler J
AD  - Department of Rhythmology, University Heart Center Lubeck, University Hospital 
      Schleswig-Holstein, 24105 Kiel, Germany.
FAU - Eitel, Charlotte
AU  - Eitel C
AUID- ORCID: 0000-0002-8733-6791
AD  - Department of Rhythmology, University Heart Center Lubeck, University Hospital 
      Schleswig-Holstein, 24105 Kiel, Germany.
FAU - Phan, Huong-Lan
AU  - Phan HL
AUID- ORCID: 0000-0002-6867-914X
AD  - Department of Rhythmology, University Heart Center Lubeck, University Hospital 
      Schleswig-Holstein, 24105 Kiel, Germany.
FAU - Keelani, Ahmad
AU  - Keelani A
AD  - Department of Rhythmology, University Heart Center Lubeck, University Hospital 
      Schleswig-Holstein, 24105 Kiel, Germany.
FAU - Cimen, Tolga
AU  - Cimen T
AUID- ORCID: 0000-0002-3374-2583
AD  - Department of Cardiology, Universitatsspital Zurich, 8091 Zurich, Switzerland.
FAU - Hatahet, Sascha
AU  - Hatahet S
AD  - Department of Rhythmology, University Heart Center Lubeck, University Hospital 
      Schleswig-Holstein, 24105 Kiel, Germany.
FAU - Trajanoski, Darko
AU  - Trajanoski D
AD  - Department of Rhythmology, University Heart Center Lubeck, University Hospital 
      Schleswig-Holstein, 24105 Kiel, Germany.
FAU - Samara, Omar
AU  - Samara O
AD  - Department of Rhythmology, University Heart Center Lubeck, University Hospital 
      Schleswig-Holstein, 24105 Kiel, Germany.
FAU - Kuck, Karl-Heinz
AU  - Kuck KH
AD  - Department of Rhythmology, University Heart Center Lubeck, University Hospital 
      Schleswig-Holstein, 24105 Kiel, Germany.
AD  - LANS Cardio, 20354 Hamburg, Germany.
FAU - Tilz, Roland R
AU  - Tilz RR
AD  - Department of Rhythmology, University Heart Center Lubeck, University Hospital 
      Schleswig-Holstein, 24105 Kiel, Germany.
AD  - LANS Cardio, 20354 Hamburg, Germany.
AD  - German Center for Cardiovascular Research (DZHK), Partner Site Lubeck, 20246 
      Hamburg, Germany.
FAU - Heeger, Christian-H
AU  - Heeger CH
AD  - Department of Rhythmology, University Heart Center Lubeck, University Hospital 
      Schleswig-Holstein, 24105 Kiel, Germany.
AD  - German Center for Cardiovascular Research (DZHK), Partner Site Lubeck, 20246 
      Hamburg, Germany.
LA  - eng
PT  - Journal Article
DEP - 20221125
PL  - Switzerland
TA  - J Clin Med
JT  - Journal of clinical medicine
JID - 101606588
PMC - PMC9739729
OTO - NOTNLM
OT  - bleeding disorders
OT  - catheter ablation
OT  - pulmonary vein isolation
COIS- B.K. received travel and congress sponsoring from Biotronik, Abbott, Impulse 
      Dynamics, and Pfizer and speaker honoraria from Biotronik, Impulse Dynamics, 
      C.T.I. GmbH and Doctrina Med; C.H.H. received travel grants and research grants 
      from Boston Scientific, Lifetech, Biosense Webster, and Cardiofocus and speaker 
      honoraria from Boston Scientific, Biosense Webster, Cardiofocus, and C.T.I. GmbH 
      and Doctrina Med; R.R.T. is a consultant for Boston Scientific, Biotronik, and 
      Biosense Webster and received speaker honoraria from Biosense Webster, Medtronic, 
      Boston Scientific, and Abbot Medical; K.H.K. reports grants and personal fees 
      from Abbott Vascular, Medtronic, Biosense Webster outside of the submitted work; 
      H.L.P. received travel grants from Cardiofocus and C.T.I. outside of the 
      submitted work; C.E. and J.V. received speaker honoraria from C.T.I. GmbH and 
      Doctrina Med. All other authors have no relevant disclosures.
EDAT- 2022/12/12 06:00
MHDA- 2022/12/12 06:01
PMCR- 2022/11/25
CRDT- 2022/12/11 01:13
PHST- 2022/10/14 00:00 [received]
PHST- 2022/11/14 00:00 [revised]
PHST- 2022/11/24 00:00 [accepted]
PHST- 2022/12/11 01:13 [entrez]
PHST- 2022/12/12 06:00 [pubmed]
PHST- 2022/12/12 06:01 [medline]
PHST- 2022/11/25 00:00 [pmc-release]
AID - jcm11236956 [pii]
AID - jcm-11-06956 [pii]
AID - 10.3390/jcm11236956 [doi]
PST - epublish
SO  - J Clin Med. 2022 Nov 25;11(23):6956. doi: 10.3390/jcm11236956.