Abstract 4141822: Factor VIII replacement therapy in patients with hemophilia undergoing pulsed-field or radiofrequency catheter ablation for atrial fibrillation

Background: Typically, hemophilia patients receive up to 6 weeks of intravenous Factor VIII replacement therapy while undergoing radiofrequency ablation (RFA) for atrial fibrillation (AF). Objective: We report the management of Factor-VIII replacement therapy in a series of hemophilia patients receiving either pulsed-field (PFA) or RFA. Methods: Consecutive hemophilia patients undergoing AF ablation were included in this series. All patients received pulmonary vein isolation (PVI) plus isolation of left atrial posterior wall using either RFA or PFA. Results: This series included 8 male patients of which 3 (37.5%) received PFA and 5 underwent RFA for drug-refractory AF. Mean CHA 2 DS 2 -VASc score were 2.67±1.15 and 2.80 ±1.48 (p=0.899) and the HAS-BLED score were 3.33± 1.53 and 2.80±1.10 (p=0.582) in the PFA and the RFA cohorts respectively. Details of pre- and post-procedural Factor VIII replacement therapy is provided in Table 1. After the procedure, patients undergoing PFA received significantly less Factor VII replacement therapy compared to those receiving RFA (PFA: 78,866.67 ± 1,761.63 vs. RF: 152,260.00 ± 29,704.51 IU, P-value: <0.001). The duration of the replacement therapy was also significantly lower in the PFA patients compared to the RFA cohort (6.65±0.229 vs 31±3.316 days, p<0.001). No peri-procedural bleeding or thromboembolic events were reported at 1-year follow-up. Conclusion: In hemophilia patients undergoing PFA for AF, factor-VIII replacement therapy and oral anticoagulants could be discontinued after one week of the procedure with no bleeding or thromboembolic complications at follow-up, whereas the duration of therapy was significantly longer following RFA.