Anticoagulation
Figure 1 shows a flow diagram of the study population. Of the enrolled
participants, we excluded 6 and 4 patients taking rivaroxaban and
edoxaban, respectively, because they did not have continuous NOACs;
therefore, 190 patients completed the study. During the study period,
all enrolled patients took their scheduled dose of rivaroxaban 20 mg (15
mg if CCr was <50mL/min) or edoxaban 60 mg (30 mg if they met
one or more dose reduction criteria)14 at night
(recommended hora somni).
Patients with or without additional per-procedural ACT-guided heparin
administration were randomly assigned in a 1:1 ratio to an ACT or a
no-ACT group, respectively. Systemic anticoagulation with NOACs was
continued for at least 3 weeks before the procedure, during the
procedure, and at least 2-months post-ablation. All patients received
intra-procedural anticoagulation with intravenous unfractionated
heparin. A bolus of heparin (100 U/kg) was routinely administered
immediately after transseptal puncture in all patients. In the ACT
group, an additional injection of heparin (30 U/kg) was administered if
the ACT at 30 min after the initial bolus administration was
<300 s. In the No-ACT group, ACT was not measured and no
additional heparin was administered.