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.