Same-Session AF Ablation, PCI Safe, Effective in COVID-19 Era

The study covered in this summary was published on ResearchSquare.com as a preprint and has not yet been peer reviewed.

Key Takeaways

• Same-session catheter ablation for atrial fibrillation (AF) and percutaneous coronary intervention (PCI) can be performed safely and successfully.

• The combined procedure can be recommended during the COVID-19 era and beyond.

Why This Matters

• Many patients have coexisting coronary artery disease and AF, and either condition may exacerbate the other.

• Interventions such as PCI and AF ablation were less often performed during the COVID-19 pandemic, potentially to the detriment of patients, in efforts to limit infection transmission.

• Performing both PCI and AF ablation at the same session may decrease the number of hospitalizations, thereby reducing opportunities for COVID-19 transmission.

Study Design

• The study prospectively enrolled 40 consecutive patients who underwent same-session PCI and AF catheter ablation between January 2020 and June 2021.

• Patients were followed in clinic 1, 3, 6, and 12 months after the procedures or on symptom recurrence.

• Analysis of the data, which came from the Cardiovascular Center of Beijing Friendship Hospital Data Bank, was retrospective.

• The two primary efficacy outcomes were development of in-stent restenosis and AF recurrence, both at 12 months.

• The primary safety outcome consisted of 90-day adverse events related to the procedure or to anticoagulation. Adverse events included vascular access site complications, major or minor bleeding, myocardial infarction, stroke, transient ischemic attack, thromboembolism, and cardiac tamponade.

• Postprocedure antithrombotic therapy consisted of triple therapy (rivaroxaban 15 mg daily, aspirin, and clopidogrel) for 1 month followed by dual therapy (rivaroxaban 15 mg daily and clopidogrel) for up to 12 months, followed — in the absence of recurrent AF ― by daily aspirin.

• Patients also received class I or III antiarrhythmic agents for 3 months followed by beta blockers and a proton pump inhibitor for 1 month.

Key Results

• The mean duration of the combined procedure was 153.6 min.

• Procedural times averaged 112.5 min for AF ablation and 44.1 min for PCI. Fluoroscopy radiation doses averaged 50.4 mGy and 942.5 mGy, respectively.

• No patients developed in-stent restenosis within 12 months; one patient developed angina and required unplanned multivessel PCI 4 months after the procedure.

• Estimated freedom from AF over 12 months was 95.7% among patients who initially had paroxysmal AF and 64.7% among patients who initially had persistent AF. There was one repeat ablation for a patient with history of persistent AF.

• There were no cases of procedural cardiac tamponade or major bleeding.

• One patient experienced a stroke, which was not considered procedure related, at 86 days.

• There were five other adverse events, all of which resolved without sequelae: three patients developed minor bleeding that did not require interruption of anticoagulation; and two developed a small access site hematoma that did not require surgery.

Limitations

• There was no control group, and the follow-up was relatively brief.

• Prevalence of AF recurrences may have been underestimated, as 12-lead electrocardiography or Holter monitoring was performed only at follow-up visits.

• No risk-benefit or cost-benefit analysis was included.

Disclosures

• No grants were received from any funding agency.

• Authors reported no competing interests.

This is a summary of a preprint research study, “Safety and Efficacy of Percutaneous Coronary Intervention Combined With Catheter Ablation in a Single Procedure for Patients With Coronary Artery Disease Complicated With Atrial Fibrillation,” written by Lizhu Chen from Beijing Friendship Hospital, Beijing, China, and colleagues, published on ResearchSquare.com, and provided to you by Medscape. This study has not yet been peer reviewed. The full text can be found on ResearchSquare.com.

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