title: Outcomes after cardioversion and atrial fibrillation ablation in patients treated with rivaroxaban and warfarin in the ROCKET AF trial.
abstract: OBJECTIVE
  This study sought to investigate the outcomes following cardioversion or catheter ablation in patients with atrial fibrillation (AF) treated with warfarin or rivaroxaban.
  
  
  BACKGROUND
  There are limited data on outcomes following cardioversion or catheter ablation in AF patients treated with factor Xa inhibitors.
  
  
  METHODS
  We compared the incidence of electrical cardioversion (ECV), pharmacologic cardioversion (PCV), or AF ablation and subsequent outcomes in patients in a post hoc analysis of the ROCKET AF (Efficacy and Safety Study of Rivaroxaban With Warfarin for the Prevention of Stroke and Non-Central Nervous System Systemic Embolism in Patients With Non-Valvular Atrial Fibrillation) trial.
  
  
  RESULTS
  Over a median follow-up of 2.1 years, 143 patients underwent ECV, 142 underwent PCV, and 79 underwent catheter ablation. The overall incidence of ECV, PCV, or AF ablation was 1.45 per 100 patient-years (n = 321; 1.44 [n = 161] in the warfarin arm, 1.46 [n = 160] in the rivaroxaban arm). The crude rates of stroke and death increased in the first 30 days after cardioversion or ablation. After adjustment for baseline differences, the long-term incidence of stroke or systemic embolism (hazard ratio [HR]: 1.38; 95% confidence interval [CI]: 0.61 to 3.11), cardiovascular death (HR: 1.57; 95% CI: 0.69 to 3.55), and death from all causes (HR: 1.75; 95% CI: 0.90 to 3.42) were not different before and after cardioversion or AF ablation. Hospitalization increased after cardioversion or AF ablation (HR: 2.01; 95% CI: 1.51 to 2.68), but there was no evidence of a differential effect by randomized treatment (p value for interaction = 0.58). The incidence of stroke or systemic embolism (1.88% vs. 1.86%) and death (1.88% vs. 3.73%) were similar in the rivaroxaban-treated and warfarin-treated groups.
  
  
  CONCLUSIONS
  Despite an increase in hospitalization, there were no differences in long-term stroke rates or survival following cardioversion or AF ablation. Outcomes were similar in patients treated with rivaroxaban or warfarin. (An Efficacy and Safety Study of Rivaroxaban With Warfarin for the Prevention of Stroke and Non-Central Nervous System Systemic Embolism in Patients With Non-Valvular Atrial Fibrillation [ROCKET AF]; NCT00403767).
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina 27710, USA. jonathan.piccini@duke.edu
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
authors.forename: Susanna R
authors.initials: SR
authors.lastname: Stevens
authors.forename: Yuliya
authors.initials: Y
authors.lastname: Lokhnygina
authors.forename: Manesh R
authors.initials: MR
authors.lastname: Patel
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Halperin
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Singer
authors.forename: Graeme J
authors.initials: GJ
authors.lastname: Hankey
authors.forename: Werner
authors.initials: W
authors.lastname: Hacke
authors.forename: Richard C
authors.initials: RC
authors.lastname: Becker
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Nessel
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mahaffey
authors.forename: Keith A A
authors.initials: KA
authors.lastname: Fox
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: Günter
authors.initials: G
authors.lastname: Breithardt
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000628:therapy*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D004554:Electric Countershock / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000627:therapeutic use; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D000069552:Rivaroxaban; D020521:Stroke / Q000453:epidemiology* / Q000517:prevention & control*; D013876:Thiophenes / Q000627:therapeutic use; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D009025:Morpholines; D013876:Thiophenes; D014859:Warfarin; D000069552:Rivaroxaban