Safety and efficacy of continuous periprocedural rivaroxaban for patients undergoing catheter ablation procedures: a retrospective registry analysis

Abstract

Objectives: The purpose of this study was to evaluate the safety and efficacy of periprocedural rivaroxaban during catheter ablation procedures atrial fibrillation (AF) and atrial flutter. Background: Catheter ablation procedures require optimal periprocedural anticoagulation for minimizing bleeding and thromboembolic complications. Rivaroxaban, a factor Xa inhibitor, was recently approved for prevention of stroke or systemic embolism in patients with nonvalvular atrial fibrillation. However, the safety and efficacy of rivaroxaban as a periprocedural anticoagulant for catheter ablation procedures are unknown. Methods: We performed a retrospective analysis from our data base including all catheter ablation procedures between February 2012 and November 2012. A total of 170 patients (mean age 62 years, 29% female) taking periprocedurally rivaroxaban were included in the study. 149 (88%) were left and 21 (12%) were right atrial procedures. Rivaroxaban 20 mg per day was taken 2 to 12 hours before the procedure. During left atrial procedures, heparin was given to maintain an activated clotting time at 270-300 seconds. Any bleeding requiring blood transfusion, hematomas requiring surgical intervention, and pericardial effusions requiring drainage (tamponade) were considered as major bleeding complications. Minor bleeding complications included small hematomas and pericardial effusions not requiring an intervention (non-tamponade). The primary endpoint was safety of the procedure including major bleedings and thromboembolic events whereas the secondary endpoint was minor bleedings. Results: Catheter ablation procedures included treatment of paroxysmal AF (n = 76, 45%), persistent AF (n = 40, 23%), atrial tachycardia (n = 33, 19%) and typical atrial flutter (n = 21, 12%). The mean procedure time was 147+/-64 min and the mean total heparine dosage per body weight was 116+/-48 IU/kg. In addition, 23 patients (14%) were taking aspirin, 2 patients (1%) clopidogrel and another 2 patients (1%) were on dual antiplatelet therapy with aspirin and clopidogrel. No major bleedings or thromboembolic events occurred. Minor bleedings in terms of groin hematoma (> 5 cm) were found in 12 (7%) patients. Conclusions: In this large study, catheter ablation procedures under continuous periprocedural rivaroxaban (20 mg per day) seems to be safe and effective.