Limitation
This is a single-center study involving a small number of patients; thus, the statistical power is limited and interpretations should be made with caution. Treatment adherence of NOACs was not carefully evaluated, and poor adherence in some patients could have caused inadequate anticoagulation. The regular dose of rivaroxaban in Japan is different from that in Europe/North America.27 Acute SCE lesions reportedly regress during the follow-up period, but we did not perform brain MRIs during the chronic phase. Several mechanisms of SCE after AF ablation are proposed rather than microthrombus, such as gaseous emboli and microparticle. The incidence of SCE is affected by multiple factors, and unmeasured procedure-related factors, such as ablation settings (contact force, the number of ablation point, power, irrigation flow rate, etc.), type of ablation catheter, procedure time, and operators, might still affect SCEs, and therefore care should be taken when interpreting the result.