Metabolic benefits of rivaroxaban in non-valvular atrial fibrillation patients after radiofrequency catheter ablation

Background and objective： Rivaroxaban is a new oral anticoagulant for stroke prevention in patients with non-valvular atrial fibrillation （NVAF）, which has less drug-food interaction than warfarin. We conducted this pro- spective randomized study to evaluate the metabolic benefits as well as the safety and efficacy with rivaroxaban versus warfarin in patients with NVAF following radiofrequency catheter ablation （RFCA）. Methods： From April to July 2014, 60 patients with NVAF undergoing RFCA were prospectively enrolled in our study. Following RFCA, all patients were randomly assigned to receive rivaroxaban （Group R, n=30） or warfarin （Group W, n=30）. Metabolic indices including serum total protein, albumin, globulin, and high-density lipoprotein （HDL） as well as bleeding, stroke, and systemic thromboembolism events were evaluated and compared during follow-up after 15, 30, 60, and 90 d of RFCA procedure. Results： Serum total protein, albumin, globulin, and HDL levels were all significantly elevated at each follow-up stage in Group R when compared to the baseline （P〈0.05 respectively）. In Group W, the metabolic indices decreased at first and then had an increasing trend. There were no deaths or thromboembolic complications in each group. The prevalence of total bleeding complications was similar between Group R and Group W （11/30, 36.7% vs. 10/30, 33.3%, P=0.70）. Conclusions： Patients with NVAF receiving rivaroxaban after RFCA procedures appear to benefit from a metabolic perspective compared with warfarin, providing practical clinical reference for the choice of the anticoagulant. Rivaroxaban seems to be as safe and effective in preventing thromboembolic events as warfarin for these patients.

Non-pulmonary vein foci induced before and after pulmonary vein isolation in patients undergoing ablation therapy for paroxysmal atrial fibrillation: incidence and clinical outcome

Objective： To evaluate the incidence and clinical outcome of adenosine triphosphate（ATP） plus isoproterenol（ISP）-induced non-pulmonary vein（PV） foci before and after circumferential PV isolation（CPVI） during index ablation in patients with paroxysmal atrial fibrillation（PAF）. Methods： In 80 consecutive patients undergoing catheter ablation for drug-refractory, symptomatic PAF at our hospital from April 2010 to January 2011, atrial fibrillation（AF） was provoked with ATP（20 mg） and ISP（20 μg/min） administration before and after CPVI. The spontaneous initiation of AF was mapped and recorded. Results： Before ablation, AF mostly originating from PVs（PV vs. non-PV, 36/70 vs. 3/70; P〈0.01） was induced in 39 patients with sinus rhythm. CPVI significantly suppressed AF inducibility; however, more non-PV foci were provoked（post-CPVI vs. pre-CPVI, 13/76 vs. 3/70; P=0.016）. Patients with pre- and post-CPVI induced AF（n=49） were divided according to non-PV foci being induced（group N, n=17） or not（group P, n=32）. After mean（19.2±8.2） months follow-up, 88.2%（15/17） and 65.6%（21/32） of patients in groups N and P, respectively, were free from AF recurrence（P=0.088）. Conclusions： ATP＋ISP administration effectively provokes non-PV foci, especially after CPVI in PAF patients. Although in this study difference did not achieve statistical significance, supplementary ablation targeting non-PV foci might benefit clinical outcome.

Retrieval of a Disconnected Left Atrial Appendage Occluder with Endoscopic Grasping Forceps

Left atrial appendage occlusion （LAAO） has been widely accepted as an alternative to oral anticoagulation for stroke prevention in patients with nonvalvular atrial fibrillation （AF）.However,the periprocedural complications such as device embolization are still challenging. Here,we reported a rare case of an AMPLATZERTM Cardiac Plug （ACP;St.Jude Medical,USA） device disconnection with the delivery cable during the LAAO procedure.