Safety of Catheter Ablation of Atrial Fibrillation Under Uninterrupted Rivaroxaban Use

• Published in: Arquivos brasileiros de cardiologia Vol. 114; no. 3; pp. 435 - 442
• Main Authors: Silva, Márcio Augusto, Futuro, Guilherme Muller de Campos, Merçon, Erick Sessa, Vasconcelos, Deborah, Agrizzi, Rovana Silva, Elias Neto, Jorge, Kuniyoshi, Ricardo
• Format: Journal Article
• Language: English; Portuguese
• Published: Brazil Sociedade Brasileira de Cardiologia - SBC 01.03.2020; Sociedade Brasileira de Cardiologia (SBC)
• Subjects: Anticoagulants; Anticoagulants/adverse effects; Anticoagulants/therapeutic use; Atrial Fibrillation; CARDIAC & CARDIOVASCULAR SYSTEMS; Catheter Ablation; Catheter Ablation/methods; Humans; Rivaroxaban; Rivaroxaban /therapeitic use; Treatment Outcome; Warfarin; Anticoagulantes/uso terapêutico; Rivaroxabana/uso terapêutico; Catheter Ablation/methods; Anticoagulants/adverse effects; Atrial Fibrillation; Fibrilação Atrial; Rivaroxaban /therapeitic use; Anticoagulants/therapeutic use; Anticoagulantes/efeitos adversos; Ablação por Cateter/métodos
• ISSN: 1678-4170; 1678-4170
• DOI: 10.36660/abc.20180386

Atrial fibrillation (AF) ablation under uninterrupted warfarin use is safe and recommended by experts. However, there is some controversy regarding direct-acting oral anticoagulants for the same purpose. To evaluate the safety of AF ablation under uninterrupted anticoagulation with rivaroxaban. A series of 130 patients underwent AF radiofrequency ablation under uninterrupted rivaroxaban use (RIV group) and was compared to a control group of 110 patients under uninterrupted warfarin use (WFR group) and therapeutic International Normalized Ratio (INR). We analyzed death, rates of thromboembolic events, major and minor bleedings, activated clotting time (ACT) levels, and heparin dose in the procedure. The ablation protocol basically consisted of circumferential isolation of the pulmonary veins guided by electroanatomic mapping. It was adopted a statistical significance of 5%. The clinical characteristics of the groups were similar, and the paroxysmal AF was the most frequent type (63% and 59%, RIV and WFR groups). A thromboembolic event occurred in the RIV group. There were 3 patients with major bleeding (RIV = 1 and WFR = 2; p = 0.5); no deaths. Basal INR was higher in the WFR group (2.5 vs. 1.2 ± 0.02; p < 0.0001), with similar basal ACT levels (123.7 ± 3 vs. 118 ± 4; p= 0, 34). A higher dose of venous heparin was used in the RIV group (9,414 ± 199 vs. 6,019 ± 185 IU; p < 0.0001) to maintain similar mean ACT levels during the procedure (350 ± 3 vs. 348.9 ± 4; p = 0.79). In the study population, AF ablation under uninterrupted rivaroxaban showed a safety profile that was equivalent to uninterrupted warfarin use with therapeutic INR.