title: Rivaroxaban and dabigatran in patients undergoing catheter ablation of atrial fibrillation.
abstract: OBJECTIVE
  The recent availability of the novel oral anticoagulants (NOACs) may have led to a change in the anticoagulation regimens of patients referred to catheter ablation of atrial fibrillation (AF). Preliminary data exist concerning dabigatran, but information regarding the safety and efficacy of rivaroxaban in this setting is currently scarce.
  
  
  RESULTS
  Of the 556 consecutive eligible patients (age 61.0 ± 9.6; 74.6% men; 61.2% paroxysmal AF) undergoing AF catheter ablation in our centre (October 2012 to September 2013) and enroled in a systematic standardized 30-day follow-up period: 192 patients were under vitamin K antagonists (VKAs), 188 under rivaroxaban, and 176 under dabigatran. Peri-procedural mortality and significant systemic or pulmonary thromboembolism (efficacy outcome), as well as bleeding events (safety outcome) during the 30 days following the ablation were evaluated according to anticoagulation regimen. During a 12-month time interval, the use of the NOACs in this population rose from <10 to 70%. Overall, the rate of events was low with no significant differences regarding: thrombo-embolic events in 1.3% (VKA 2.1%; rivaroxaban 1.1%; dabigatran 0.6%; P = 0.410); major bleeding in 2.3% (VKA 4.2%; rivaroxaban 1.6%; dabigatran 1.1%; P = 0.112), and minor bleeding 1.4% (VKA 2.1%; rivaroxaban 1.6%; dabigatran 0.6%; P = 0.464). No fatal events were observed.
  
  
  CONCLUSIONS
  The use of the NOAC in patients undergoing catheter ablation of AF has rapidly evolved (seven-fold) over 1 year. These preliminary data suggest that rivaroxaban and dabigatran in the setting of catheter ablation of AF are efficient and safe, compared with the traditional VKA.
authors.affiliation: Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal rui_providencia@yahoo.com.
authors.forename: Rui
authors.initials: R
authors.lastname: Providência
authors.affiliation: Paris Cardiovascular Research Center, 75015 Paris, France.
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
authors.affiliation: Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Albenque
authors.affiliation: Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Combes
authors.affiliation: Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Combes
authors.affiliation: Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France.
authors.forename: François
authors.initials: F
authors.lastname: Jourda
authors.affiliation: Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France.
authors.forename: Hassiba
authors.initials: H
authors.lastname: Hireche
authors.affiliation: Serviço de Cardiologia, Hospital de Santo André, Centro Hospitalar Leiria-Pombal, 2410-197 Leiria, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Morais
authors.affiliation: Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Boveda
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001562:Benzimidazoles / Q000008:administration & dosage* / Q000009:adverse effects; D017115:Catheter Ablation / Q000009:adverse effects*; D000069604:Dabigatran; D011307:Drug Prescriptions; D017723:Drug Utilization Review; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000008:administration & dosage* / Q000009:adverse effects; D011174:Portugal; D010818:Practice Patterns, Physicians' / Q000639:trends; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000069552:Rivaroxaban; D013876:Thiophenes / Q000008:administration & dosage* / Q000009:adverse effects; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D015091:beta-Alanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D009025:Morpholines; D013876:Thiophenes; D015091:beta-Alanine; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: Arrhythmia; Atrial fibrillation; Bleeding; Cryoablation; Dabigatran; Fluindione; Rivaroxaban; Stroke; Thromboembolism; Vitamin K antagonists