title: Efficacy and safety of uninterrupted rivaroxaban taken preoperatively for radiofrequency catheter ablation of atrial fibrillation compared to uninterrupted warfarin.
abstract: OBJECTIVE
  Data on uninterrupted rivaroxaban taken preoperatively for radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) is limited. The aim was to evaluate safety and efficacy of rivaroxaban taken in the morning for AF ablation, especially with regard to asymptomatic cerebral emboli (ACE) and anticoagulation parameters.
  
  
  METHODS
  We prospectively evaluated 147 consecutive patients who underwent RFCA (mean age 66, 110 patients with paroxysmal AF), 76 of whom were on rivaroxaban, 71 on warfarin. The drugs were continued throughout the periprocedural period, including the morning of RFCA. Heparin infusion was maintained during RFCA to achieve an activated clotting time (ACT) of >300 s.
  
  
  RESULTS
  There were no significant differences in basic patient characteristics and ablation procedure between the two groups. ACT during the procedure correlated significantly with prothrombin time and international normalized ratio in each group (correlation coefficient 0.799 in rivaroxaban, 0.705 in warfarin, p < 0.01). D-dimer level was more elevated after RFCA in the warfarin group than in the rivaroxaban group (warfarin 0.37 ± 0.28 to 0.67 ± 0.81, rivaroxaban 0.41 ± 0.33 to 0.51 ± 0.25, p = 0.02). One major bleeding event (1.3%), a cardiac tamponade, was observed in the warfarin group. No symptomatic thromboembolic complications were observed in either group. Two patients (3%) in each group had minor bleeding, specifically, groin hematoma. Postprocedural MRI indicated ACE in 5/46 (11%) patients in the rivaroxaban group and 4/39 (10%) in the warfarin group (p = 0.99).
  
  
  CONCLUSIONS
  Uninterrupted rivaroxaban taken preoperatively for AF ablation is clinically effective and safe. Its ACE profile is similar to warfarin. ACT is sufficient for monitoring anticoagulation.
authors.affiliation: Heart Rhythm Center, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo, 113-8519, Japan. sumtao1978@yahoo.co.jp.|Department of Cardiology, Ome Municipal General Hospital, Tokyo, Japan. sumtao1978@yahoo.co.jp.
authors.forename: Susumu
authors.initials: S
authors.lastname: Tao
authors.affiliation: Department of Cardiology, Ome Municipal General Hospital, Tokyo, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Otomo
authors.affiliation: Department of Cardiology, Ome Municipal General Hospital, Tokyo, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ono
authors.affiliation: Department of Cardiology, Ome Municipal General Hospital, Tokyo, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Osaka
authors.affiliation: Department of Cardiology, Ome Municipal General Hospital, Tokyo, Japan.
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Hirao
authors.affiliation: Department of Cardiology, Ome Municipal General Hospital, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Koura
authors.affiliation: Department of Cardiology, Ome Municipal General Hospital, Tokyo, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Manno
authors.affiliation: Department of Cardiology, Ome Municipal General Hospital, Tokyo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ueshima
authors.affiliation: Department of Cardiology, Ome Municipal General Hospital, Tokyo, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Shimizu
authors.affiliation: Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
authors.affiliation: Heart Rhythm Center, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo, 113-8519, Japan.
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirao
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015984:Causality; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D065427:Factor Xa Inhibitors / Q000008:administration & dosage; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000453:epidemiology* / Q000517:prevention & control*; D007564:Japan / Q000453:epidemiology; D008297:Male; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000517:prevention & control; D011292:Premedication; D011300:Preoperative Care / Q000379:methods; D015995:Prevalence; D012307:Risk Factors; D000069552:Rivaroxaban / Q000008:administration & dosage*; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D014859:Warfarin; D000069552:Rivaroxaban
keywords: Asymptomatic cerebral emboli; Atrial fibrillation; Periprocedural anticoagulant; Radiofrequency ablation; Rivaroxaban