Figure-of-eight suture to achieve hemostasis in atrial fibrillation catheter ablation without interruption of direct oral anticoagulants

Introduction Atrial fibrillation (AF) catheter ablation is more and more performed without interruption of direct oral anticoagulants (DOAC), with a risk of puncture site complications. Purpose To evaluate safety and feasibility of figure-of eight-suture to achieve hemostasis of puncture site in AF catheter ablation without interruption of DOAC. Methods All patients receiving DOAC who underwent AF catheter ablation from November 2017 to December 2018 were prospectively enrolled. Unfractionated heparin (UH) was administrated during the procedure to obtain a target ACT > 300s. At the end of the procedure, a last ACT was assayed and a figure-of-eight suture was performed to remove the sheaths, without further manual compression. Puncture site complications were recorded during the hospitalization and at the 3 months control consultation. Results One hundred and thirty-eight patients underwent AF catheter ablation without DOAC interruption with a median follow-up of 119 days (99–149). Median last ACT before sheath removal was 300s (259–337). Figure-of-eight suture was able to be performed in all patients. No protamine reversal was necessary to obtain puncture site hemostasis. Puncture site complications occured in 8 patients (hematoma: 4; 2.9% − pseudoaneurysm: 1;0.7% − arteriovenous fistula (AVF): 2;1.4%). All complications were detected during hospitalization except for one patient for which pseudoaneurysm was diagnosed and treated ambulatory. Only 2 (1.4%) patients needed to be treated surgically for AVF. No death was reported. Conclusion Figure-of-eight suture is safe and feasible to achieve puncture site hemostasis, without manual compression or protamine reversal, in AF catheter ablation without DOAC interruption.