Peri-procedural Oral Anticoagulation
All patients were treated with NOACs or VKA for ≥4 weeks before AF ablation (dabigatran 150 mg/110 mg b.i.d., rivaroxaban 15 mg/10 mg q.d., apixaban 5 mg/2.5 mg b.i.d., edoxaban 60 mg/30 mg q.d., warfarin q.d.). Approved dose criteria were specific to each NOAC according to the patient’s renal function, weight, age, and concomitant medications, as indicated in approved package inserts (PIs).6,7 In patients on VKA, a target international normalized ratio (INR) was set to 2.0-3.0 but the therapeutic intensity was lowered (PT-INR 1.6-2.6) in elderly patients (≥70 years).8 The quality of VKA control was evaluated by monitoring the PT-INR and calculating the time in therapeutic range (TTR).9 In all patients, the initial choice/dose of anticoagulants was decided by the physicians/cardiologists who first diagnosed AF; the anticoagulants were continued before ablation without change, interruption, and heparin bridging. NOACs and VKA were used without interruption during the procedure. Once-daily drugs (rivaroxaban and edoxaban) were administered in the morning and the catheter ablation was scheduled in the afternoon. Inappropriate dose reduction was defined as the low dose treatment due to physician’s decision/preference that did not follow the PIs in each drug. A proton pump inhibitor was prescribed in all patients to minimize the risk of esophageal injury.