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Open Access
CC BY 4.0 · TH Open 2019; 03(04): e335-e339
DOI: 10.1055/s-0039-1698756
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Catheter Ablation for Atrial Fibrillation in Patients with Hemophilia or von Willebrand Disease

Autor*innen

  • Paul R. van der Valk

    1   Van Creveldkliniek, University Medical Center, University Utrecht, Utrecht, The Netherlands

  • Eveline P. Mauser-Bunschoten

    1   Van Creveldkliniek, University Medical Center, University Utrecht, Utrecht, The Netherlands

  • Jeroen F. van der Heijden

    2   Division Heart and Lung, Cardiology, Electrophysiology, UMC Utrecht, Utrecht, The Netherlands

  • Roger E. G. Schutgens

    1   Van Creveldkliniek, University Medical Center, University Utrecht, Utrecht, The Netherlands
Weitere Informationen

Publikationsverlauf

23. Mai 2019

05. September 2019

Publikationsdatum:
24. Oktober 2019 (online)

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Abstract

Background Management of atrial fibrillation (AF) is complex in patients with bleeding disorders. Catheter ablation such as pulmonary vein isolation (PVI) has been suggested in cases with bleeding disorders. However, data on safety are missing. This report describes the outcome of PVI in patients with bleeding disorders.

Methods A retrospective study in our hemophilia treatment center of patients who underwent a PVI in 2014 to 2018. PVI was done according to local protocol. Clotting factor was given periprocedural. Postprocedural anticoagulation was given for at least 4 weeks, with clotting factor suppletion if needed to maintain factor VIII (FVIII) levels >0.20 IU/mL.

Results and Discussion Five patients with hemophilia and one with von Willebrand disease were included. Eight PVIs were performed. Target FVIII levels (>0.80 IU/mL) were met before the procedure. Postprocedural anticoagulation was given: vitamin K antagonist (VKA) or direct oral anticoagulant (DOAC) dabigatran. All patients obtained long-term sinus rhythm, in two patients after a second PVI. However, late recurrent AF occurred in one patient after 42 months. A notable incidence of groin bleeds was observed: two of eight interventions (25%) compared with 0.9% in the general population. Bleeding seemed to be related to agitation, early mobilization, and bridging of VKA with low molecular weight heparin (LMWH). No relevant bleeding was observed when on DOAC therapy.

Conclusion PVI seems to be effective in the case of bleeding disorders. To reduce the groin bleeds agitation and early mobilization should be avoided and DOAC is preferred over bridging VKA with LMWH.

Keywords

atrial fibrillation - Hemophilia A - von Willebrand Disease - catheter ablation - anticoagulant - bleeding

Authors' Contributions

P.R. van der Valk performed the research, analyzed the data, and wrote the manuscript. J.F. van der Heijden wrote part of the of the manuscript, concerning the cardiac intervention, performed and supervised the PVIs. E.P. Mauser-Bunschoten supervised the manuscript. R.E.G. Schutgens designed the research and edited the manuscript.