Catheter Ablation for Atrial Fibrillation in Patients with Hemophilia or von Willebrand Disease
| Autor: | Roger E. G. Schutgens, Paul R. van der Valk, Jeroen F. van der Heijden, Eveline P. Mauser-Bunschoten |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
lcsh:Diseases of the circulatory (Cardiovascular) system
medicine.medical_specialty medicine.drug_class medicine.medical_treatment Low molecular weight heparin Catheter ablation Hemophilia A Dabigatran catheter ablation medicine Von Willebrand disease Journal Article atrial fibrillation Clotting factor business.industry Anticoagulant anticoagulant Atrial fibrillation Vitamin K antagonist medicine.disease bleeding Surgery lcsh:RC666-701 Original Article business von Willebrand disease medicine.drug |
| Zdroj: | TH open : companion journal to thrombosis and haemostasis, 3(4), e335 TH Open, Vol 03, Iss 04, Pp e335-e339 (2019) TH Open: Companion Journal to Thrombosis and Haemostasis |
| ISSN: | 2512-9465 |
| Popis: | Background Management of atrial fibrillation (AF) is complex in patients with bleeding disorders. Catheter ablation such as pulmonary vein isolation (PVI) has been suggested in cases with bleeding disorders. However, data on safety are missing. This report describes the outcome of PVI in patients with bleeding disorders. Methods A retrospective study in our hemophilia treatment center of patients who underwent a PVI in 2014 to 2018. PVI was done according to local protocol. Clotting factor was given periprocedural. Postprocedural anticoagulation was given for at least 4 weeks, with clotting factor suppletion if needed to maintain factor VIII (FVIII) levels >0.20 IU/mL. Results and Discussion Five patients with hemophilia and one with von Willebrand disease were included. Eight PVIs were performed. Target FVIII levels (>0.80 IU/mL) were met before the procedure. Postprocedural anticoagulation was given: vitamin K antagonist (VKA) or direct oral anticoagulant (DOAC) dabigatran. All patients obtained long-term sinus rhythm, in two patients after a second PVI. However, late recurrent AF occurred in one patient after 42 months. A notable incidence of groin bleeds was observed: two of eight interventions (25%) compared with 0.9% in the general population. Bleeding seemed to be related to agitation, early mobilization, and bridging of VKA with low molecular weight heparin (LMWH). No relevant bleeding was observed when on DOAC therapy. Conclusion PVI seems to be effective in the case of bleeding disorders. To reduce the groin bleeds agitation and early mobilization should be avoided and DOAC is preferred over bridging VKA with LMWH. |
| Databáze: | OpenAIRE |
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