Outcomes Following Cardioversion And Atrial Fibrillation Ablation In Patients Treated With Rivaroxaban And Warfarin In The Rocket Af Trial

Background: There are limited data regarding cardioversion and atrial fibrillation (AF) ablation in patients receiving novel, oral anti-Xa inhibitors. Methods: We compared the incidence of electrical cardioversion (ECV), pharmacologic cardioversion (PCV), or AF ablation and subsequent outcomes in the ROCKET AF trial. Results: Over a median follow-up of 2.1 years, 143 patients underwent ECV, 142 underwent PCV, and 79 underwent catheter ablation. The rate of ECV, PCV, or AF ablation was 1.44 per 100 patient-years in the warfarin arm and 1.46 per 100 patient-years in the rivaroxaban arm. In the adjusted analysis, the incidences of stroke or systemic embolism (HR 1.04; 95% CI 0.46-2.33), cardiovascular death (HR 1.24; 95% CI 0.55-2.78), and all-cause death (HR 1.43; 95% CI 0.74-2.77) were not significantly different following ECV, PCV, or AF ablation. Hospitalization was increased following ECV, PCV, or AF ablation (HR 2.16; 95% CI 1.63-2.86), and there was no evidence of a differential effect by randomized treatment (p for interaction=0.90). Event counts were similar in the rivaroxaban- and warfarin-treated patients following ECV, PCV, or AF ablation, including stroke or systemic embolism or death from any cause (Figure). Conclusions: Despite an increase in hospitalization, there was no difference in long-term stroke rates or survival following cardioversion or AF ablation. Outcomes following cardioversion or ablation were similar in those treated with rivaroxaban or warfarin.