Novel oral anticoagulants, such as rivaroxaban, are increasingly being used instead of warfarin for stroke prevention in patients with atrial fibrillation (AF). In addition, radiofrequency catheter ablation for AF that is nonresponsive to antiarrhythmic drug therapy is becoming an ever more common procedure. Thelack of data on the safety and efficacy of uninterrupted rivaroxaban therapy in patients undergoing catheter ablation for AF, therefore, represents a substantial gap in the clinical evidence base. Lakkireddy et al. have published the first prospective, multicentre report on the use of rivaroxaban in this setting.

Rivaroxaban is a direct factor Xa inhibitor that was approved by the FDA in 2011 for the prevention of thromboembolism in patients with AF. Using data from a US registry, the investigators compared 30-day outcomes in 321 patients receiving once daily rivaroxaban with those of 321 patients receiving warfarin. All participants underwent pulmonary vein antral isolation with manual catheter ablation. Both anticoagulant regimens were taken as prescribed and not interrupted for the ablation procedure.

In the whole cohort, 47 patients (7.3%) experienced bleeding, and two patients (0.3%) had a transient ischaemic attack. At 30-days, no differences between the two groups were observed in the incidence of major or minor bleeding or thromboembolic events. None of the patients in either group died or experienced a stroke. The ongoing VENTURE-AF randomized trial will provide additional insight into the role of rivaroxaban in these patients.