Background: Patients with atrial fibrillation (AF) routinely undergo different imaging modalities for the evaluation of the\nleft atrial (LA) appendage to rule out thrombus prior to the AF ablation procedure. Recently, uninterrupted novel oral\nanticoagulants were introduced for patients undergoing atrial fibrillation (AF) ablation to minimize the peri-procedural\nthromboembolism risk. We performed a retrospective analysis to evaluate the safety of uninterrupted rivaroxaban and\nwhether transesophageal (TEE) or intracardiac echocardiography (ICE) is necessary for patients undergoing AF ablation.\nMethods: Data from 332 consecutive patients (42% females, aged 64 �± 11 years) with AF undergoing either TEE\n(n = 115) prior to catheter ablation or ICE (n = 217) for the detection of LA thrombus were analyzed. All patients were\non uninterrupted rivaroxaban during, and for at least, 4 weeks before the procedure. Heparin bolus was administered\nin all patients before transseptal puncture to maintain a target activated clotting time of >350 s.\nResults: A total of 277 patients (80.4%) had paroxysmal AF. The average CHA2DS2VASc score was 2.11 �± 0.91 in the\nTEE group and 2.46 �± 0.61 in the ICE group. The CHA2DS2VASc score was â�¥2 in 64 (55.7%) and 214 (98.6%) patients in\nthe TEE and ICE groups, respectively. The left atrial appendage was adequately visualized in all cases. None of the\npatients have an identifiable LA thrombus either in the TEE group or the ICE group. One (0.3%) thromboembolic\nperiprocedural stroke occurred in a patient with long-standing persistent AF in the TEE group.\nConclusions: This study illustrates that performing AF ablation with ICE guidance on uninterrupted rivaroxaban for at\nleast 4 weeks even without TEE is feasible and safe.
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