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.