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.