title: Evaluation of safety and efficacy of periprocedural use of rivaroxaban and apixaban in catheter ablation for atrial fibrillation.
abstract: We previously reported that dabigatran increased the risk of microthromboembolism and hemopericardium compared with warfarin. The safety of non-vitamin-K-antagonist oral anticoagulants (NOACs) in the periprocedural use of atrial fibrillation (AF) ablation is controversial. This study aimed to compare the incidence of asymptomatic cerebral microthromboembolism and hemopericardium in AF ablation among periprocedural use of rivaroxaban, apixaban, and warfarin.
  
  
  
  This study was a prospective, randomized registry. Patients taking NOACs upon visiting our hospital were randomly assigned into 2 groups; rivaroxaban and apixaban. Warfarin was continued in patients taking warfarin. Asymptomatic cerebral microthromboembolism was evaluated by magnetic resonance imaging on the day after the ablation procedure. In 176 consecutive patients (101 paroxysmal, and 75 persistent AF), rivaroxaban was used in 55, apixaban in 51, and warfarin in 70. There were no symptomatic cerebral infarctions in this study. Asymptomatic cerebral microthromboembolism was detected in 32 (18.4%) patients; nine (16.4%) with rivaroxaban, 10 (20%, p=0.80; vs. rivaroxaban) with apixaban, and 13 (18.8%, p=0.81; vs. rivaroxaban) with warfarin. Hemopericardium occurred in 5 (2.8%) patients; 2 with rivaroxaban, 1 with apixaban (p=1.0; vs. rivaroxaban), and 2 with warfarin (p=1.0; vs. rivaroxaban). In multivariate analysis, concomitant coronary angiography (p<0.05, odds ratio 5.73) was a predictor of cerebral thromboembolism.
  
  
  
  The incidence of asymptomatic cerebral microthromboembolism and hemopericardium in AF ablation is similar among the periprocedural use of rivaroxaban, apixaban, and warfarin.
authors.affiliation: Department of Cardiovascular Medicine and Hypertension, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan.
authors.forename: Akino
authors.initials: A
authors.lastname: Yoshimura
authors.affiliation: Department of Cardiovascular Medicine and Hypertension, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan.
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Iriki
authors.affiliation: Department of Cardiovascular Medicine and Hypertension, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ichiki
authors.affiliation: Department of Cardiovascular Medicine and Hypertension, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan. Electronic address: oketani@m.kufm.kagoshima-u.ac.jp.
authors.forename: Naoya
authors.initials: N
authors.lastname: Oketani
authors.affiliation: Department of Cardiovascular Medicine and Hypertension, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Okui
authors.affiliation: Clinical Laboratory Unit, Medical and Dental Hospital, Kagoshima University, Kagoshima, Japan.
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Maenosono
authors.affiliation: Clinical Laboratory Unit, Medical and Dental Hospital, Kagoshima University, Kagoshima, Japan.
authors.forename: Fuminori
authors.initials: F
authors.lastname: Namino
authors.affiliation: Department of Cardiovascular Medicine and Hypertension, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Miyata
authors.affiliation: Department of Cardiovascular Medicine and Hypertension, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Ohishi
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods*; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D065427:Factor Xa Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D020767:Intracranial Thrombosis / Q000139:chemically induced / Q000453:epidemiology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000139:chemically induced / Q000453:epidemiology; D011446:Prospective Studies; D011720:Pyrazoles / Q000008:administration & dosage* / Q000009:adverse effects; D011728:Pyridones / Q000008:administration & dosage* / Q000009:adverse effects; D012042:Registries; D000069552:Rivaroxaban / Q000008:administration & dosage* / Q000009:adverse effects; D014859:Warfarin / Q000008:administration & dosage
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D014859:Warfarin; D000069552:Rivaroxaban
keywords: Ablation; Anticoagulant; Atrial fibrillation; Complication