{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T04:53:07Z","timestamp":1760244787988,"version":"build-2065373602"},"reference-count":24,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2022,11,25]],"date-time":"2022-11-25T00:00:00Z","timestamp":1669334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Aims\/Objectives: Patients with bleeding disorders are a rare and complex population in catheter ablation (CA) procedures. The most common types of bleeding disorders are von Willebrand disease (VWD) and hemophilia A (HA). Patients with VWD or HA tend to have a higher risk of bleeding complications compared to other patients. There is a lack of data concerning peri- and postinterventional coagulation treatment. We sought to assess the optimal management of patients with VWD and HA referred for catheter ablation procedures. Methods and Results: In this study, we analyzed patients with VWD or HA undergoing CA procedures at two centers in Germany and Switzerland between 2016 and 2021. Clotting factors were administered in conjunction with hemostaseological recommendations. CA was performed as per the institutional standard. During the procedure, unfractionated heparin (UFH) was given intravenously with respect to the activated clotting time (ACT). Primary endpoints included the feasibility of the procedure, bleeding complications, and thromboembolic events during the procedure. Secondary endpoints included bleeding complications and thromboembolic events up to one year after catheter ablation. A total of seven patients (three VWD Type I, one VWD Type IIa, three HA) underwent 10 catheter ablation procedures (pulmonary vein isolation (PVI): two \u00d7 radiofrequency (RF), one \u00d7 laser balloon (LB), one \u00d7 cryoballoon (CB); PVI + cavotricuspid isthmus (CTI): one \u00d7 RF; PVI + left atrial appendage isolation (LAAI): one \u00d7 RF; Premature ventricular contraction (PVC): three \u00d7 RF; Atrioventricular nodal reentrant tachycardia (AVNRT): one \u00d7 RF). VWD patients received 2000\u20133000 IE Wilate i.v. 30 to 45 min prior to ablation. Patients with HA received 2000\u20133000 IE factor VIII before the procedure. All patients undergoing PVI received UFH (cumulative dose 9000\u201318,000 IE) with a target ACT of &gt;300 s. All patients after PVI were started on oral anticoagulation (OAC) 12 h after ablation. Two patients received aspirin (acetylsalicylic acid; ASA) for 4 weeks after the ablation of left-sided PVCs. No anticoagulation was prescribed after slow pathway modulation in a case with AVNRT. No bleeding complications or thromboembolic events were reported. During a follow-up of one year, one case of gastrointestinal bleeding occurred following OAC withdrawal after LAA occlusion. Conclusions: After the substitution of clotting factors, catheter ablation in patients with VWD and HA seems to be safe and feasible.<\/jats:p>","DOI":"10.3390\/jcm11236956","type":"journal-article","created":{"date-parts":[[2022,11,28]],"date-time":"2022-11-28T06:04:36Z","timestamp":1669615476000},"page":"6956","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Safety and Feasibility of Catheter Ablation Procedures in Patients with Bleeding Disorders"],"prefix":"10.3390","volume":"11","author":[{"given":"Marcel","family":"Feher","sequence":"first","affiliation":[{"name":"Department of Rhythmology, University Heart Center L\u00fcbeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ardan M.","family":"Saguner","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Universit\u00e4tsspital Zurich, 8091 Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6881-871X","authenticated-orcid":false,"given":"Bettina","family":"Kirstein","sequence":"additional","affiliation":[{"name":"Department of Rhythmology, University Heart Center L\u00fcbeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Vogler","sequence":"additional","affiliation":[{"name":"Department of Rhythmology, University Heart Center L\u00fcbeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8733-6791","authenticated-orcid":false,"given":"Charlotte","family":"Eitel","sequence":"additional","affiliation":[{"name":"Department of Rhythmology, University Heart Center L\u00fcbeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6867-914X","authenticated-orcid":false,"given":"Huong-Lan","family":"Phan","sequence":"additional","affiliation":[{"name":"Department of Rhythmology, University Heart Center L\u00fcbeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad","family":"Keelani","sequence":"additional","affiliation":[{"name":"Department of Rhythmology, University Heart Center L\u00fcbeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3374-2583","authenticated-orcid":false,"given":"Tolga","family":"Cimen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Universit\u00e4tsspital Zurich, 8091 Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sascha","family":"Hatahet","sequence":"additional","affiliation":[{"name":"Department of Rhythmology, University Heart Center L\u00fcbeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darko","family":"Trajanoski","sequence":"additional","affiliation":[{"name":"Department of Rhythmology, University Heart Center L\u00fcbeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omar","family":"Samara","sequence":"additional","affiliation":[{"name":"Department of Rhythmology, University Heart Center L\u00fcbeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl-Heinz","family":"Kuck","sequence":"additional","affiliation":[{"name":"Department of Rhythmology, University Heart Center L\u00fcbeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany"},{"name":"LANS Cardio, 20354 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roland R.","family":"Tilz","sequence":"additional","affiliation":[{"name":"Department of Rhythmology, University Heart Center L\u00fcbeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany"},{"name":"LANS Cardio, 20354 Hamburg, Germany"},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site L\u00fcbeck, 20246 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian-H.","family":"Heeger","sequence":"additional","affiliation":[{"name":"Department of Rhythmology, University Heart Center L\u00fcbeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany"},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site L\u00fcbeck, 20246 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1111\/j.1538-7836.2009.03661.x","article-title":"The prevalence of symptomatic von Willebrand disease in primary care practice","volume":"8","author":"Bowman","year":"2009","journal-title":"J. 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