Baseline characteristics
There were 208 consecutive left atrial ablation cases performed. Two
cases were excluded as there was a contraindication to heparin
administration, with the resultant use of an alternate intravenous
anticoagulant. Another 6 procedures were excluded, as 3 patients had
repeat ablation for which procedures existed in both the usual care and
protocol guided cohorts. After exclusions, 200 patients were analyzed,
100 in each cohort. There was no difference between the usual care and
protocol guided cohorts in regard to demographics, antiplatelet
medications prior to procedure, medical comorbidities, mean glomerular
filtration rate (GFR), and mean left ventricular ejection fraction
(Table 1).
Oral anticoagulant use prior to procedure was similar between the two
cohorts. There were 78 and 77 patients on DOACs in the usual care and
protocol guided arms respectively, with an increase in apixaban (from 49
to 54 patients), and decrease in rivaroxaban (from 27 to 21 patients)
use in the protocol guided cohort. In the usual care cohort there were
12 patients on uninterrupted warfarin, and 10 patients on no oral
anticoagulant prior to procedure. This compared similarly to the
protocol guided cohort as there were 11 patients on uninterrupted
warfarin, and 12 patients on no oral anticoagulant prior to procedure.
The usual care cohort included 15 of the 78 patients (19.2%) patients
for which their direct oral anticoagulant was held for more than 2 doses
prior to procedure, all of which were on twice daily dosed medications,
and only two patients were interrupted for more than 3 doses. This
compared to 7 out of 77 (9.1%) in the protocol guided cohort for which
6 patients were on twice daily dosed medications, and only one patient
was interrupted for more than 3 doses.