HRS 2021: DOACs reduce risk of stroke in patients undergoing left ventricular RFA

Dhanunjaya Lakkireddy

Use of direct oral anticoagulants (DOACs) in patients undergoing ventricular tachycardia radio frequency ablation (RFA) is associated with a reduced risk of transient ischaemic attack or stroke, and asymptomatic, magnetic resonance imaging (MRI) detected cerebrovascular event.

This is according to the findings of STROKE-VT, a multicentre, randomised trial that studied the differences in cerebrovascular events between DOACs and aspirin post-procedurally, in patients undergoing LVA-RFA. The findings were presented by Dhanunjaya Lakkireddy (Kansas City Heart Rhythm Institute, Kansas, USA) during a late-breaking trial session at the 2021 Heart Rhythm Society annual meeting (HRS 2021, 28–31 July, Boston, USA and virtual) and simultaneously published in JACC: Clinical Electrophysiology.

A total of 246 patients scheduled for LVA-RFA were randomised 1:1 post-procedurally to receive DOAC or aspirin, with investigators assessing the incidence of stroke or transient ischaemic attack (TIA), or MRI-detected asymptomatic cerebrovascular events at 24 hours and 30 days follow-up.

Secondary endpoints included procedure-related complications—a composite of any vascular complication, pericardial complication, heart block, thromboembolic event excluding stroke or TIA—and in-hospital mortality.

Investigators found that there were no differences between groups regarding baseline and ablation characteristics, except for the percentage of patients undergoing ventricular tachycardia (VT) ablation, rate of amiodarone use, and total RFA time. Post-procedure cerebrovascular events (stroke and TIA) were lower in the DOAC arm versus the aspirin arm (0% vs. 6.5%, p<0.001 and 4.9% vs. 18%, p < 0.001; respectively). Patients in the aspirin group had higher MRI-detected asymptomatic cerebrovascular events compared to the DOAC group both at 24 hours (23% vs. 12%, p=0.03) and 30 days (18% vs. 6.5%, p=0.006) follow-up. The acute procedure-related complication and in-hospital mortality were similar between the two groups.

These results led Lakkireddy and colleagues to conclude that DOAC utilisation following endocardial or epicardial ablation for LVA-RFA was associated with reduced risk of TIA or stroke, and asymptomatic MRI-detected cerebrovascular events.

“The STROKE-VT trial helps us answer a longstanding question around the best way to lower procedure-related risks for patients coming out of an ablation,” said  Lakkireddy. “Moving forward, we hope the findings encourage electrophysiologists to use anticoagulants after ablations to reduce cerebrovascular events in a patient population that is already very sick and at high-risk of stroke.”


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