Female Sex as a Major Risk Factor for Dabigatran‐Induced Esophagitis in Atrial Fibrillation Ablation

Background Uninterrupted dabigatran administration is recommended for periprocedural anticoagulation during catheter ablation (CA) for atrial fibrillation (AF). Although dabigatran‐induced esophagitis (DIE) is not uncommon after CA, its risk factors remain unclear. Methods We retrospectively enrolled consecutive AF patients who underwent CA at our hospital between November 2017 and October 2018. Unless contraindicated, all direct oral anticoagulants (DOACs) were switched to dabigatran for the periprocedural period. All patients underwent esophagogastroduodenoscopy (EGD) on the day after the index CA. Patients were divided into the DIE or non‐DIE groups based on the EGD findings. Factors associated with DIE were evaluated. Results Among 193 patients (66 ± 10 years, 33% female), DIE was identified in 18.7% of patients. DIE occurred more frequently in women, in patients co‐prescribed aspirin, and who had their anticoagulant switched from other DOACs to dabigatran on admission. In the multivariate analysis, female sex remained an independent predictor of DIE (odds ratio: 4.02, 95% confidence interval: 1.86–8.71, p < 0.01). Conclusion Female sex is independently associated with an increased risk of developing DIE in the periprocedural period of AF ablation.