RESUMO
BACKGROUND: Data regarding uninterrupted oral anticoagulation in patients with chronic kidney disease (CKD) during catheter ablation for left atrial arrhythmias is limited. This study aimed to evaluate the safety and efficacy of periprocedural uninterrupted direct oral anticoagulants (DOAC) compared with uninterrupted phenprocoumon in patients with CKD undergoing left atrial catheter ablation. METHODS AND RESULTS: We conducted a retrospective single-center study of patients who underwent left atrial catheter ablation between 2016 and 2019 with underlying chronic kidney disease (glomerular filtration rate (GFR) between 15 and 45 ml/min). The primary objective of this study was to investigate whether direct oral anticoagulant (DOAC) therapy or warfarin presents a superior safety profile in patients with chronic kidney disease (CKD) undergoing left atrial catheter ablation. We compared periprocedural complications (arteriovenous fistula, aneurysm, significant hematoma (> 5 cm)) and/or bleeding (drop in hemoglobin of >2 g/dl, pericardial effusion, retroperitoneal bleeding, other bleeding, stroke) between patients receiving either uninterrupted DOAC or warfarin therapy. Secondary analysis included patient baseline characteristics as well as procedural data. A total of 188 patients (female n = 108 (57%), mean age 75.3 ± 8.1 years, mean GFR 36.8 ± 6 ml/min) were included in this study. Underlying arrhythmias were atrial fibrillation (n = 104, 55.3%) and atypical atrial flutter (n = 84, 44.7%). Of these, n = 132 patients (70%) were under a DOAC medication, and n = 56 (30%) were under phenprocoumon. Major groin complications including pseudoaneurysm and/or AV fistula occurred in 8.9% of patients in the phenprocoumon group vs. 11.3% of patients in the DOAC group, which was not statistically significant (p = 0.62). Incidence of cardiac tamponade (2.3% vs. 0%; p = 0.55) and stroke (0% vs. 0%) were low in both DOAC and phenprocoumon groups with similar post-procedural drops in hemoglobin levels (1.1±1 g/dl vs 1.1±0.9 g/dl; p = 0.71). CONCLUSION: The type of anticoagulation had no significant influence on bleeding or thromboembolic events as well as groin complications in this retrospective study. Despite observing an increased rate of groin complications, the uninterrupted use of DOAC or phenprocoumon during left atrial catheter ablation in patients with CKD appears to be feasible and effective.
RESUMO
UNLABELLED: The pathophysiology of neurocardiogenic syncope (NCS) is only poorly understood. Several studies indicate that NCS is associated with an imbalance of the autonomic nervous system (ANS). We hypothesized that pediatric patients with NCS exhibit alterations of the neurovegetative status also during asymptomatic time periods. To test this hypothesis the non-invasive method of Heart Rate Variability (HRV)-Analysis was used. METHOD: Holter records (12 channel, 180 Hz; obtained during an asymptomatic 24-hour period) of 32 patients (18 male, 14 female, mean age 14.6 yrs) with a history of syncope and a positive Head-Up tilt (HUT) were compared to the recordings of 33 healthy control subjects (19 male, 14 female, mean age 13.5 yrs) with negative history of syncope and HUT. Time domain and frequency domain features were calculated. Analysis segments were divided in different signal duration groups (1, 3, 6, 24 hours). RESULTS: For all time scales the standard deviation of wavelet coefficients yields the best discrimination properties. Analysis of the total time duration (24h) shows only moderate discrimination (sensitivity 84%, specificity 45%) between patient and controls. However, analysis of 3 and 6 hour segments (starting and 6 a.m.) showed significant discrimination: sigma wave scale 13 (6-9 a.m.) sensitivity 78%, specificity 71%., sigma wave scale 11 (6-12 a.m.) sensitivity 84%, specificity 61%. The best combination of two parameters is denoted by SDNN and sigma wave scale 11 (6-12 a.m.) with sensitivity 70%, specificity 75%. CONCLUSION: The results indicate that during an asymptomatic 24-hour-period patients with NCS exhibit an imbalance of the ANS especially in the morning (6-12 a.m.). The findings suggest a time-dependent increased sympathetic or reduced vagal activity in pediatric patients with NCS. Patients could benefit from a time-adjusted medical therapy with beta-blocking agents.