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

Pulmonary vein isolation (PVI) appears effective in mitigating the effects of bleeding disorders such as hemophilia, according to new findings of a study published in TH Open.

Management of atrial fibrillation (AF) is complex in patients with bleeding disorders,” the study authors wrote in their abstract. “Catheter ablation such as (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.”

In this retrospective study, five patients with hemophilia and one with von Willebrand disease were included, and eight PVIs were performed according to local protocol. The researchers administered clotting factor during PVI, and anticoagulation, which included vitamin K antagonist (VKA) or direct oral anticoagulant (DOAC) dabigatran, which was administered following PVI for at least four weeks.

According to the results of the study, two patients achieved long-term sinus rhythm following a second PVI. However, the researchers observed late recurrent AF occurred in one patient after 42 months, as well as a notable incidence of groin bleeds in two of eight interventions (25%) compared with 0.9% in the general population. The researchers noted that bleeding seemed to be linked to agitation, early mobilization, and bridging of VKA with low molecular weight heparin (LMWH). They observed no notable bleeding in patients when on DOAC therapy.

“Our results suggest that PVI is effective and a generally safe procedure in patients with bleeding disorders, provided that a strict control of hemostasis is attained and preferably a DOAC is used as anticoagulation,” the authors wrote. “Because of the unexpected significant groin hematomas in two patients (on VKA with LMWH bridging) despite complete clotting factor correction for at least 24 hours, agitation during and the first hours after the procedure and early mobilization should be avoided. Furthermore, also in patients with bleeding disorders, DOAC seems safer compared with bridging of VKA with LMWH.”