Prospective Randomized Study of the Safety and Efficacy of Interrupted Anticoagulant’s Therapy in the Perioperative Period of Catheter Ablation for Atrial Fibrillation: The SEACOAST Rhythm AF Trial

Abstract

: No prospective, randomized study has been conducted to date in Japan comparing the use of warfarin and rivaroxaban for preventing thrombotic and bleeding events in the perioperative period of catheter ablation （ CA ） for atrial fibrillation （ AF ） . This was a prospective, open-label randomized study assessing the safety and efficacy of warfarin and rivaroxaban in the perioperative period of CA for AF. Thrombotic events including silent cerebral lesion （ SCL ） detected by magnetic resonance imaging （ MRI ） , bleeding events, and coagulation test results were assessed in correlation with interrupted warfarin or rivaroxaban in the perioperative period of CA for AF. Finally, thirty-six patients （ 18 men; aged 65 ± 9.4 years ） who underwent CA for AF were prospectively enrolled. instance of symptomatic cerebral infarction occurred, but 12 of 36 patients （ 33.3 ％） showed new SCLs during the postprocedural cerebral MRI examination （ 8/21 in the rivaroxaban group and 4/15 in the warfarin group; P ＝ 0.47 ） . The duration of hospitalization was significantly shorter in the rivaroxaban group than in the warfarin group （ 6 vs. 8 days; P ＝ 0.0135 ） . The incidence of minor bleeding was significantly lower in the rivaroxaban group than in the warfarin group （ 0 ％ vs. 26.6 ％ ; P ＝ 0.078 ） . D-dimer concentration was significantly higher in the SCL group than in the no-SCL group （ P ＝ 0.024 ） under warfarin, while the values of protein S （ P ＝ 0.017 ） and prothrombin time （ P ＝ 0.018 ） were significantly lower in the SCL group than in the no-SCL group under rivaroxaban. CA is safer than warfarin usage with respect to the incidence of minor bleeding. In patients receiving rivaroxaban therapy, a lower protein S level may be correlated with the incidence of SCL in CA.