Hemorrhagic and thromboembolic complications in catheter ablation for atrial fibrillation

Objective. To analyze the incidence of hemorrhagic (HC) and thromboembolic complications (TC) in patients with atrial fibrillation undergoing pulmonary vein isolation or catheter ablation of cavotricuspid isthmus depending on perioperative anticoagulation. Material and methods. This is a prospective study of patients undergoing catheter ablation. The first group included patients in 2016—2018 who underwent perioperative interruption of anticoagulation with injection of low molecular weight heparins. The second group included patients in 2021—2022 who underwent surgical treatment under regular intake of anticoagulant. The incidence of intraoperative and delayed TC and HC was analyzed. We compared effectiveness and safety of various perioperative anticoagulation regimens and assessed significance of various factors of complications. Primary endpoint was major HC and any arterial thromboembolic event, secondary endpoint — minor HC. Results. The first group included 78 patients (12 (15.4%) patients received warfarin, 66 (74.6%) ones received direct oral anticoagulants (DOACs)). The second group included 92 patients (1 (1.1%) received warfarin, 91 (98.9%) received DOACs). Patients in the first group were significantly more likely to achieve primary (p=0.0456) and secondary (p=0.0256) endpoints. No factors influencing the incidence of major HC were identified. Intraoperative electrical cardioversion significantly affected the incidence of minor HC (p=0.007), patient age (p=0.018) and anticoagulation with warfarin upon admission (p=0.040) — the incidence of TC. Conclusion. Minimally interrupted administration of anticoagulants significantly reduces the number of TC and HC.