title: Safety of continuous periprocedural rivaroxaban for patients undergoing left atrial catheter ablation procedures.
abstract: BACKGROUND
  This study aimed to evaluate the safety of continuous periprocedural rivaroxaban administration during left atrial radiofrequency ablation (RFA) in comparison with uninterrupted oral vitamin K antagonist administration. Data about the use of rivaroxaban in the setting of left atrial RFA procedures are lacking.
  
  
  RESULTS
  The study cohort included 544 patients (mean age, 63±10 years) who underwent left atrial RFA procedures between February 2012 and May 2013. All patients (n=272) receiving uninterrupted periprocedural rivaroxaban 15 or 20 mg/d before the procedure (rivaroxaban) were matched by age, sex, and type of rhythm disorder with an equal number of patients managed with uninterrupted vitamin K antagonist phenprocoumon (international normalized ratio, 2-3). During RFA, heparin was given intravenously to maintain an activated clotting time at 270 to 300 s. The safety end point was a composite of bleeding, thromboembolic events, and death. There were no thromboembolic complications and no deaths in either group. The prevalence of major bleeding complications was similar in both groups (1 tamponade in RivG and 1 groin hematoma requiring transfusion in phenprocoumon). Minor bleeding complications occurred equally in both groups (20 of 272; 7% in the rivaroxaban versus 33 of 272, 12% in the phenprocoumon; P=0.08). In multivariable analyses, female sex was associated with a greater risk of complications (odds ratio, 1.96; 95% confidence interval, 1.10-3.49).
  
  
  CONCLUSIONS
  In patients undergoing left atrial RFA, continuous periprocedural rivaroxaban use seems to be as safe as uninterrupted periprocedural phenprocoumon administration.
authors: From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany. roger.dillier@bluewin.ch.
authors: Roger
authors: R
authors: Dillier
authors: From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany.
authors: Sonia
authors: S
authors: Ammar
authors: From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany.
authors: Gabriele
authors: G
authors: Hessling
authors: From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany.
authors: Bernhard
authors: B
authors: Kaess
authors: From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany.
authors: Herribert
authors: H
authors: Pavaci
authors: From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany.
authors: Alessandra
authors: A
authors: Buiatti
authors: From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany.
authors: Verena
authors: V
authors: Semmler
authors: From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany.
authors: Susanne
authors: S
authors: Kathan
authors: From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany.
authors: Monika
authors: M
authors: Hofmann
authors: From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany.
authors: Carsten
authors: C
authors: Lennerz
authors: From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany.
authors: Christof
authors: C
authors: Kolb
authors: From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany.
authors: Tilko
authors: T
authors: Reents
authors: From the Department of Cardiovascular Diseases in Adults, German Heart Center Munich, Technical University, Munich, Germany.
authors: Isabel
authors: I
authors: Deisenhofer
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D005260:Female; D005858:Germany; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery; D006470:Hemorrhage / Q000139:chemically induced / Q000401:mortality / Q000628:therapy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000008:administration & dosage* / Q000009:adverse effects; D015999:Multivariate Analysis; D016017:Odds Ratio; D010644:Phenprocoumon / Q000008:administration & dosage; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D000069552:Rivaroxaban; D012737:Sex Factors; D013876:Thiophenes / Q000008:administration & dosage* / Q000009:adverse effects; D013923:Thromboembolism / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D009025:Morpholines; D013876:Thiophenes; D000069552:Rivaroxaban; D010644:Phenprocoumon
keywords: atrial fibrillation; catheter ablation; hemorrhage; rivaroxaban