Luigi Di Biase, MD, PhD, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, USA, and Texas Cardiac Arrhythmia Institute, Austin, Texas, USA, presented a poster of data from a study that evaluated the role of transesophageal echocardiography (TEE) in patients with atrial fibrillation (AF) undergoing ablation and receiving uninterrupted non–vitamin K antagonist oral anticoagulants (NOACs).

It is recommended that patients with AF who are receiving an NOAC and require radiofrequency catheter ablation should be monitored by preprocedural TEE. The purpose of this study was to determine if TEE is necessary in patients who received uninterrupted NOAC therapy (apixaban or rivaroxaban) during ablation for AF.

In this multicenter prospective registry study, 970 patients with AF who were undergoing radiofrequency catheter ablation and taking apixaban (n = 514) or rivaroxaban (n = 456) were enrolled. Patients took apixaban or rivaroxaban for ≥ 4 weeks prior to the procedure. In addition, all patients received a heparin bolus prior to trans-septal catheterization in order to maintain the activated clotting time (ACT) > 300 seconds. A subset of 54 patients was evaluated for silent cerebral ischemia (SCI) via diffusion magnetic resonance imaging (dMRI). At baseline, the mean age was 69.5 years, and 65.6% of patients were men. In addition, 85% of patients had nonparoxysmal AF, the mean CHA₂DS₂-VASc score was 3.01, and almost 63% of patients had a CHADS₂ score ≥ 2.

There were no reports of left atrial appendage thrombus among the patients and 42% had “smoke” on intracardiac echocardiogram. No patient experienced a clinical stroke. In addition, dMRI demonstrated no new SCI among the patients. However, 1 patient with long-standing persistent AF who received uninterrupted rivaroxaban experienced a transient ischemic attack.

In conclusion, Dr Di Biase stated that the data from this study suggest that in patients with AF undergoing radiofrequency catheter ablation, TEE is not required to improve safety in those who receive uninterrupted apixaban or rivaroxaban during the ablation.