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Efficacy and safety of uninterrupted rivaroxaban taken preoperatively for radiofrequency catheter ablation of atrial fibrillation compared to uninterrupted warfarin

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

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.

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Acknowledgments

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Authors and Affiliations

  1. Heart Rhythm Center, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo, 113-8519, Japan

    Susumu Tao & Kenzo Hirao

  2. Department of Cardiology, Ome Municipal General Hospital, Tokyo, Japan

    Susumu Tao, Kenichiro Otomo, Yuichi Ono, Yuki Osaka, Tatsuhiko Hirao, Kenji Koura, Tomoko Manno, Daisuke Ueshima & Shigeo Shimizu

  3. Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan

    Mitsuaki Isobe

Authors
  1. Susumu Tao
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  2. Kenichiro Otomo
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Correspondence to Susumu Tao.

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The hospital’s ethics committee approved the study protocol, and written informed consent was obtained from all patients before enrollment.

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Tao, S., Otomo, K., Ono, Y. et al. Efficacy and safety of uninterrupted rivaroxaban taken preoperatively for radiofrequency catheter ablation of atrial fibrillation compared to uninterrupted warfarin. J Interv Card Electrophysiol 48, 167–175 (2017). https://doi.org/10.1007/s10840-016-0214-6

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  • DOI: https://doi.org/10.1007/s10840-016-0214-6

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