Decreased oral function in Japanese inpatients with schizophrenia.

AIM: Oral function in patients with schizophrenia has not been well-characterized. To address this, we performed a cross-sectional study of oral function in Japanese inpatients with schizophrenia. METHODS: We measured oral function, including occlusal force, tongue-lip motor function, tongue pressure, and masticatory function in 130 Japanese inpatients with schizophrenia. We then compared the frequency of clinical signs of oral hypofunction among 63 non-elderly and 67 elderly inpatients with schizophrenia, as well as data from 98 elderly control participants from a previous Japanese study. RESULTS: The frequency of reduced occlusal force was significantly higher in the elderly inpatients (76.2%) than in the non-elderly inpatients (43.9%) and elderly controls (43.9%). The frequency of decreased tongue-lip motor function in non-elderly inpatients (96.8%) and elderly inpatients (97.0%) was significantly higher than that in elderly controls (56.1%). The frequency of decreased tongue pressure in non-elderly inpatients (66.1%) and elderly inpatients (80.7%) was significantly higher than that in elderly controls (43.9%). Finally, the frequency of decreased masticatory function was highest in elderly inpatients (76.5%), followed by non-elderly inpatients (54.8%) and elderly controls (15.3%). CONCLUSION: Oral function was decreased in both non-elderly and elderly Japanese inpatients with schizophrenia compared with elderly controls.

Activation pattern within Koch's triangle during sinus rhythm in patients with and without atrioventricular nodal reentrant tachycardia.

BACKGROUND: Several studies have visualized the slow pathway during sinus rhythm using high-density mapping of Koch's triangle (KT) in patients with atrioventricular nodal reentrant tachycardia (AVNRT). However, it is unclear whether the slow pathway can be visualized in all people. Therefore, we evaluated the activation pattern within KT during sinus rhythm in patients with and without AVNRT. METHODS: High-density mapping using the Advisor HD Grid mapping catheter (Abbott) within KT during sinus rhythm was created in 10 patients with slow-fast AVNRT and 30 patients without AVNRT. RESULTS: In 8 (80%) patients with AVNRT, the activation pattern pivoting around a block line (BL) within KT was observed. In 12 (40%) patients without AVNRT, similar activation pattern pivoting around BL was observed, but jump was observed in 11 (92%) of these patients. In all patients, the activation pattern pivoting around BL was observed in 17 (85%) of 20 patients with jump, but only 3 (15%) of 20 patients without jump (p < 0.0001). During jump, there was a long period of no potential from the last atrial potential within KT to the His bundle potential, suggesting the slow pathway conduction through the rightward inferior extension that cannot be visualized. A linear ablation between the pivot point and the septal tricuspid annulus was successful for slow-fast AVNRT. CONCLUSION: Although the slow pathway could not be visualized using high-density mapping during sinus rhythm, the activation pattern pivoting around BL within KT was observed in most patients with the dual pathway physiology, with or without AVNRT.

Initial multicenter clinical experience with the first-generation endoscopic guided laser balloon in Japan.

BACKGROUND: Isolation of the pulmonary veins (PVs) is the golden standard for atrial fibrillation (AF) ablation. To achieve a permanent PV isolation, the endoscopic guided HeartLight laser balloon system was invented. We analyzed the safety and efficacy of this laser balloon system. METHODS AND RESULTS: Three hundred four patients from 21 investigational sites inside Japan were enrolled in this study. One thousand sixty-two out of 1175 PVs (90.4%) were isolated using the HeartLight laser balloon. The isolation rate of the left superior, left inferior, right superior, and right inferior PVs was 87.8%, 91.3%, 91.6%, and 92.1%, respectively. The procedure time, defined as the time from the venous access to taking out the balloon, was 155 ± 39 min. The fluoroscopic time was 44 ± 25 min. The mean follow-up period was 309 ± 125 days. The freedom from AF recurrence at 3 months was 89.0% and at 12 months 82.1%. Adverse events occurred in 22 patients (7.2%) including phrenic nerve injury lasting more than 3 months in 1.6% and strokes in 1.0% of the patients. CONCLUSIONS: This initial experience demonstrated that the laser balloon ablation was feasible for PV isolation in Japanese AF patients.

Association Between the Number of Remaining Teeth and Body Mass Index in Japanese Inpatients with Schizophrenia.

Purpose: There is little evidence regarding the effects of dental status on body mass index (BMI) in inpatients with schizophrenia. Thus, we performed a cross-sectional study to explore the associations between the number of remaining teeth and BMI in Japanese inpatients with schizophrenia. Patients and Methods: We performed multiple regression analysis to assess the effects of potential predictors (age, sex, number of remaining teeth, number of antipsychotics prescribed, chlorpromazine equivalent dose, and antipsychotic type) on BMI in 212 inpatients with schizophrenia. We then compared the number of remaining teeth between inpatients with schizophrenia and the Japanese general population (3283 individuals) from the Japan Dental Diseases Survey 2016, using an analysis of covariance with age and sex as covariates. Results: Multiple regression analysis showed that the number of remaining teeth and the number of antipsychotics prescribed were significantly correlated with BMI (standardized regression coefficient = 0.201 and 0.235, respectively). In the analysis of covariance, inpatients with schizophrenia had significantly fewer remaining teeth compared with the Japanese general population (mean 14.8 [standard deviation: 10.9] vs mean 23.0 [standard deviation: 8.1]). Conclusion: These results suggested that tooth loss and antipsychotic polypharmacy affect BMI in inpatients with schizophrenia, and that inpatients with schizophrenia lose more teeth compared with the general population.

Real-World Investigation on Anticoagulation Management Before and After Catheter Ablation for Atrial Fibrillation in Japan　- Periprocedural and Long-Term Outcomes.

BACKGROUND: Optimal periprocedural oral anticoagulant (OAC) therapy before catheter ablation (CA) for atrial fibrillation (AF) and the safety profile of OAC discontinuation during the remote period (from 31 days and up to 1 year after CA) have not been well defined.Methods and Results: The RYOUMA registry is a prospective multicenter observational study of Japanese patients who underwent CA for AF in 2017-2018. Of the 3,072 patients, 82.3% received minimally interrupted direct-acting OACs (DOACs) and 10.2% received uninterrupted DOACs. Both uninterrupted and minimally interrupted DOACs were associated with an extremely low thromboembolic event rate. Female, long-standing persistent AF, low creatinine clearance, hepatic disorder, and high intraprocedural heparin dose were independent factors associated with periprocedural major bleeding. At 1 year after CA, DOAC was continued in 55.9% of patients and warfarin in 56.4%. The incidence of thromboembolic and major bleeding events for 1 year was 0.3% and 1.2%, respectively. Age ≥73 years, dementia, and AF recurrence were independently associated with major bleeding events. Univariate analyses revealed that warfarin continuation and off-label overdose of DOACs were risk factors for major bleeding after CA. CONCLUSIONS: High intraprocedural dose of heparin was associated with periprocedural major bleeding events. At 1 year after CA, over half of the patients had continued OAC therapy. Thromboembolic events were extremely low; however, major bleeding occurred in 1.2%. Age ≥73 years, dementia, and AF recurrence were independently associated with major bleeding after CA.

Cryoballoon ablation for paroxysmal atrial fibrillation in Japan: 2-year safety and efficacy results from the Cryo AF Global Registry.

PURPOSE: Catheter ablation is a recommended rhythm control therapy after failed or intolerant antiarrhythmic drug (AAD) treatment for patients with atrial fibrillation (AF). This study evaluates clinical performance and safety of pulmonary vein isolation (PVI) using the cryoballoon (Arctic Front Advance) in Japan. METHODS: Cryo AF Global Registry is a prospective, multi-center registry. Patients with paroxysmal AF (PAF) were treated at 10 Japanese hospitals. Efficacy was evaluated by freedom from a ≥ 30-s recurrence of AF/atrial flutter (AFL)/atrial tachycardia (AT), AF-related symptoms, and quality of life using the EQ-5D-3L questionnaire. The safety endpoint was serious device- and procedure-related adverse events. RESULTS: The study included 352 patients with PAF (65 ± 10 years of age, 36% female, 36% without prior failure of AAD). Mean duration since first diagnosis of AF was 3.0 ± 5.5 years. Serious device- and procedure-related adverse event rate was 2.6% (95% CI: 1.2-4.8%). Freedom from AF/AFL/AT was 88.5% (95% CI: 84.7-91.4%) at 12 months and 86.7% (95% CI: 81.1-90.8%) at 24 months. The number of patients with ≥ 1 AF symptom was significantly decreased from 88% at enrollment to 22% (p < 0.01) at 12-month follow-up. General quality of life using EQ-5D did not improve significantly after 12 months in the summary score. However, in the visual analog scale score, there was improvement (5.8 ± 18.4; p < 0.01). CONCLUSIONS: This study demonstrates that cryoablation used for PVI is a safe and effective treatment in real-world use for patients with PAF in Japan.

Advantages and challenges for noninvasive atrial fibrillation ablation.

PURPOSE: Although catheter ablation is an effective therapy for atrial fibrillation (AF), risks remain and improved efficacy is desired. Stereotactic radiotherapy is a well-established therapy used to noninvasively treat malignancies with precision. We sought to evaluate stereotactic arrhythmia radioablation (STAR) as a therapeutic option for treating AF. METHODS AND RESULTS: Three cancer patients with drug refractory AF were enrolled. Planning software using 3-D CT of the left atrium was used to design a desired ablation volume encompassing antral circumferential pulmonary vein isolation, roof and floor lines to create a "box" lesion set. After planning, patients were treated in the radioablation suite. STAR was able to deliver the intended radiation dose to the target in all 3 patients. No complications were observed over a follow-up period of 24 months. One patient with paroxysmal AF died from deterioration of cancer. The autopsy revealed evidence of fibroblasts and fibrogenesis in the region of atrial tissues targeted with radioablation. In one of these patients, left atrial posterior wall electrograms recorded from the esophagus before and 3 months after STAR indicated successful electrical isolation. CONCLUSIONS: This is the first report of non-invasive radioablation of the left atrium with demonstration of successful electrical isolation. Although STAR may be safe and effective in delivering ablative energy to the left atrium, further evaluation is warranted regarding effectiveness.

Long-term efficacy and safety of anticoagulation after atrial fibrillation ablation: data from the JACRE registry.

BACKGROUND: Catheter ablation (CA) is an important strategy for managing atrial fibrillation (AF). However, long-term anticoagulation strategies and clinical outcomes following CA, including thromboembolism and bleeding, have not yet been elucidated. METHODS: We established a prospective registry, called the JACRE registry, for patients on rivaroxaban or warfarin administration who received CA for AF. The outcomes up to 30 days following the procedure were reported previously. The present study involved longer follow-up of patients enrolled in this registry to evaluate long-term anticoagulation strategies and clinical outcomes. RESULTS: Data of 975 patients (rivaroxaban, n = 823; warfarin, n = 152) were collected from 27 institutes. Patient population had mean age 63.7 ± 10.3 years, 710 (72.8%) males, mean CHA2DS2-VASc score 1.9 ± 1.5, and mean follow-up period 28.7 ± 12.7 months after the index procedure. Anticoagulants were continued in 496 (50.9%) patients during the follow-up. Thromboembolism occurred in 3 patients, hemorrhagic stroke in 5, and major bleeding events in 9 (annualized event rate, 0.13%, 0.22%, and 0.40% per patient-year, respectively). There were no differences in the composite event rate of thromboembolism and International Society on Thrombosis and Haemostasis major bleeding between rivaroxaban and warfarin cohorts (0.53% and 0.55% per patient-year, respectively). CONCLUSIONS: Long-term incidence of thromboembolism was extremely low in patients with AF treated with CA, while that of major bleeding was not especially low. Clinical Trials Registry: UMIN000032829 / UMIN000032830.

High-power, short-duration ablation during Box isolation for atrial fibrillation.

BACKGROUND: It has been demonstrated that a high-power, short-duration (HPSD) ablation during pulmonary vein (PV) isolation is effective and safe. However, studies about the HPSD ablation during the posterior wall isolation, the Box isolation (BOXI), are limited. We evaluated the efficacy, feasibility, and safety of HPSD ablation during BOXI. METHODS: One-hundred sixty patients with all types of atrial fibrillation underwent BOXI with HPSD ablation (n = 80) or conventional technique (n = 80). In the HPSD group, ablation was performed with 50 W and a target lesion size index of 5.0 using a contact force (CF) sensing catheter. Ablation near the esophagus was performed with 50 W for 5 seconds and a CF < 10 g. In the conventional group, ablation was performed with 30-40 W for 30 seconds, but 20 W near the esophagus. RESULTS: The BOXI creation (26 ± 8 minutes vs 47 ± 17 minutes, P < .0001) and procedure (65 ± 12 minutes vs 87 ± 23 minutes, P < .0001) times were significantly shorter in the HPSD group than the conventional group. The number of pacing capture sites did not differ between the two groups. No complications including gastrointestinal symptoms occurred. The atrial tachyarrhythmia-free rate at 12-months after a single procedure was 86.3% in the HPSD group and 76.3% in the conventional group, respectively (P = .132). The incidence of PV reconnections and gaps in the lines during the second procedure did not differ between the two groups. CONCLUSION: The BOXI with HPSD ablation is effective, feasible, and safe with short BOXI creation and procedure times without reducing the clinical outcomes.

Impact of Box Isolation on Rotors and Multiple Wavelets in Persistent Atrial Fibrillation.

BACKGROUND: Additional benefits of posterior left atrial (LA) box isolation (BOXI) over pulmonary vein isolation (PVI) in persistent atrial fibrillation (perAF) have been reported, but the mechanism is still unclear. We evaluated the effects of BOXI on rotors and multiple wavelets in the whole LA.Methods and Results:Twenty patients with perAF (including 12 cases of longstanding perAF) underwent PVI. Real-time phase mapping (ExTRa Mapping) was performed in the whole LA during AF. Subsequently, BOXI was added and re-ExTRa Mapping was performed again at the same site. The nonpassively activated ratio (%NP), the ratio of the form of rotors and multiple wavelets to the recording time, was compared before and after BOXI. After BOXI, the %NP significantly decreased in the anterior wall (from 53±22% to 39±23%, P=0.010), inferior wall (from 51±16% to 34±19%, P=0.001), and LA appendage (from 23±27% to 16±19%, P=0.049). However, there were no significant differences in the septum (49±19% vs. 49±18%, P=0.562) or lateral wall (41±19% vs. 38±15%, P=0.526). CONCLUSIONS: BOXI not only reduced the critical mass for maintenance of AF, but also decreased the rotors and multiple wavelets in the anterior wall, inferior wall and LA appendage during perAF.

HAS-BLED score as a predictor of bleeding complications from catheter ablation of atrial fibrillation: A subanalysis of the Japanese Anti-Coagulation Regimen Exploration in AF Catheter Ablation Registries.

BACKGROUND: The ATRIA, Outcomes Registry for Better Informed Treatment (ORBIT), and modified (m) HAS-BLED (excluding a labile international normalized ratio element from the HAS-BLED score) scores are currently used to predict the bleeding risk in atrial fibrillation (AF) patients receiving oral anticoagulant treatment. We assessed the usefulness of these scores in estimating the catheter ablation (CA)-related bleeding risk in AF patients from the Japanese Anti-Coagulation Regimen Exploration in AF Catheter Ablation Registry (JACRE). METHODS: We investigated 1322 consecutive patients enrolled in the prospective, multicenter JACRE registry of AF patients receiving CA. The patients also received rivaroxaban (n=1118) or warfarin (n=204) during the perioperative period and complications were monitored for 30 days post-surgery. RESULTS: Periprocedural bleeding complications occurred in 42 patients (3.2%) and were significantly associated with the mHAS-BLED [hazard ratio=1.46, 95% confidence interval (1.06-2.01)], ATRIA [1.16 (1.00-1.35)], and ORBIT [1.29 (1.06-1.57)] scores. However, only the mHAS-BLED score predicted a significantly greater bleeding prevalence in the high-score group than in the low-score group stratified by a threshold maximizing the sensitivity and specificity (threshold=3, p<0.001). The incidence of all bleeding complications was significantly lower in the rivaroxaban cohort in patients with a mHAS-BLED score ≥3 (rivaroxaban vs. warfarin cohort, 5.56% vs. 25%, p=0.028). CONCLUSIONS: All three common bleeding scores were associated with a periprocedural risk of CA-related bleeding in AF patients and a mHAS-BLED score ≥3 best distinguished high-risk patients from low-risk patients.

Effects of additional ablation of low-voltage areas after Box isolation for persistent atrial fibrillation.

BACKGROUND: Previous studies reported that ablation of low-voltage areas (LVAs) after pulmonary vein isolation (PVI) improves the success rate in persistent atrial fibrillation (PerAF) patients with LVAs. However, the need for LVA ablation in addition to the posterior left atrial isolation, Box isolation (BOXI), for PerAF is unclear. We evaluated the effects of LVA ablation after BOXI for PerAF with LVAs. METHODS: In 115 patients with PerAF (75 longstanding PerAF), LA voltage maps were created during sinus rhythm after PVI. Subsequently, BOXI was performed. In 61 patients without LVAs (<0.5 mV), BOXI alone was performed. Fifty-four patients with LVAs were randomly assigned to BOXI plus LVA ablation (33 patients) or BOXI alone (21 patients). RESULTS: The rate of AF termination or cardioversion after BOXI was significantly higher than that after PVI (100% vs 88%, P < 0.001). The inducibility of atrial tachyarrhythmia after BOXI was significantly lower than that after PVI (27% vs 100%, P < 0.001). During 24 ± 9 months of follow-up after a single procedure, atrial tachyarrhythmia-free rate in the patients with LVAs, was significantly lower than that without LVAs (65% vs 82%, P = 0.043). However, the success rate was not significantly different between the BOXI plus LVA ablation group and the BOXI alone group of patients with LVAs (67% vs 62%, P = 0.722). CONCLUSION: BOXI facilitates AF termination and its non-inducibility. Among patients with PerAF, BOXI alone may be adequate in cases without LVAs. Although cases with LVAs have higher risk of AF recurrence, additional LVA ablation does not improve the outcomes much.

Psychometric validation of anti-clot treatment scale and treatment satisfaction questionnaire for medication version II in Japanese patients with atrial fibrillation.

Aims: The Anti-Clot Treatment Scale (ACTS) and Treatment Satisfaction Questionnaire for Medication version II (TSQM-II) are validated treatment satisfaction patient-reported outcome (PRO) instruments. The ACTS includes two domains: Burdens and Benefits; the TSQM-II includes four: Effectiveness, Side Effects, Convenience, and Global Satisfaction. Japanese-language versions of the ACTS and TSQM-II have been developed and linguistically validated. This study aimed to assess their psychometric properties in Japanese patients with atrial fibrillation (AF). Materials and methods: ACTS and TSQM-II data from 534 patients with AF were collected in a Japanese post-marketing surveillance study of a direct oral-anticoagulant, rivaroxaban. Four key psychometric properties, in line with best practice guidelines from the US Food and Drug Administration, were examined using traditional psychometric methods: acceptability, scaling assumptions, reliability (i.e. internal consistency reliability, test-retest reliability), and construct validity (i.e. convergent validity and known groups). Results: ACTS Burdens and Benefits and TSQM-II Effectiveness, Convenience, and Global Satisfaction scales were found to be acceptable (e.g. item-level missing data at baseline <4%), with all scales having good internal consistency (Cronbach's alpha > 0.80). test-retest reproducibility intraclass correlation coefficients for the ACTS Burdens and Benefits were 0.59 and 0.65, respectively, and between 0.54-0.61 for the TSQM-II scales. Known-groups validity for the ACTS and TSQM-II was supported by differences in scale scores by positive and negative impact (p < 0.05). Correlations between the ACTS and TSQM-II (convergent validity) were lower than expected (range r = 0.09-0.48), but in line with the original ACTS development study. Limitations: Evaluation of test-retest reproducibility was limited by assessment period, which was longer (3 months) than recommended guidelines (usually up to 2 weeks). Conclusions: Overall, Japanese versions of ACTS and TSQM-II scales satisfied internal consistency reliability and traditional validity criteria. Our study supports the ACTS and TSQM-II as appropriate PRO instruments to measure satisfaction with anticoagulant treatment in Japanese patients with AF. Trial registration: NCT01598051, clinicaltrials.gov; registered April 20, 2012.

Influence of substrate modification in catheter ablation of atrial fibrillation on the incidence of acute complications: Analysis of 10 795 procedures in J-CARAF Study 2011-2016.

BACKGROUND AND PURPOSE: In expectation of better outcome of catheter ablation of atrial fibrillation (AF), several strategies of extra-PV (pulmonary vein) substrate modification have been utilized. We assessed whether substrate modification or ablation of extra-PV source is a predictor of complications. METHODS: Japanese Heart Rhythm Society requested electrophysiology centers to register the data of patients who underwent AF ablation. RESULTS: The data of 10 795 AF ablation cases (age; 63.8 ± 10.6 years) treated during 2011-2016 were registered. Pericardial effusion (n = 105), massive bleeding (n = 108), stroke (n = 6), atrial-esophageal fistula (n = 2), and other 114 complications occurred in 323 patients (3.0%). Univariate analysis revealed that age â‰§ 65 years, female gender, heart failure, CHA2DS2-VASc≧3, hemodialysis, deep sedation, and complex fractionated atrial electrogram (CFAE)-guided ablation ([+] vs [-] = 4.3% vs 2.8%, P = .005) were related with the higher incidence of complications. Redo session, 3-D imaging system ([+] vs [-]: 4.4% vs 2.9%, P = .017), and periprocedural dabigatran were related with the lower incidence of complications. None of the linear ablation of the left atrium, ganglionated plexi ablation, and superior vena cava ablation affected the incidence of complications. Multiple logistic regression analysis showed that in addition to 3-D imaging system, age â‰§ 65 years, redo session, and deep sedation, CFAE ablation was an independent predictor of the risk of complications (OR 1.78, P = .001). Specifically, implantation of a permanent pacemaker due to emerging sinus node dysfunction was frequent after CFAE ablation (CFAE [+] vs [-] = 4/1047 vs 2/9748, P < .001). CONCLUSIONS: Among extra-PV ablation strategies, CFAE-guided ablation is a predictor of ablation-related complications.

Patient-reported treatment satisfaction with rivaroxaban in Japanese non-valvular atrial fibrillation patients: an observational study.

OBJECTIVES: Rivaroxaban has previously been shown to be as efficacious and safe as warfarin for the prevention of stroke in non-valvular atrial fibrillation (NVAF). Therefore, treatment satisfaction becomes an important consideration. Here we examine treatment satisfaction in Japanese NVAF patients who were switched from warfarin to rivaroxaban. METHODS: Patient-reported outcome (PRO) data were collected as part of a prospective, multi-center, post-marketing surveillance (PMS) of a direct oral-anticoagulant, rivaroxaban, in Japan. The Anti-Clot Treatment Scale (ACTS) and the Treatment Satisfaction Questionnaire for Medication version II (TSQM-II) were collected at baseline, month 3, and month 6. Change in scores from baseline to month 3 and month 6 were assessed. Exploratory analyses included change in scores by patient characteristics. Safety and effectiveness of rivaroxaban were also assessed. RESULTS: ACTS Burdens scores significantly improved at month 3 (54.6 ± 6.3) and month 6 (54.5 ± 6.5) compared to baseline (51.0 ± 7.6) (p < .001). ACTS Benefits score remained stable over time (baseline = 10.1 ± 2.8, month 3 = 10.2 ± 3.1, month 6 = 10.1 ± 3.1). Mean TSQM-II sub-scale scores significantly improved at month 3 and month 6 compared to baseline for all four domains (all p < .001). CONCLUSIONS: Findings suggest treatment satisfaction may improve in Japanese NVAF patients after a switch from warfarin to rivaroxaban. Higher treatment satisfaction may translate into improved treatment adherence, which is critical for the long-term prevention of stroke.

Effects and Risks of Heparin Bridging and Different Modes of Interruption/Resumption of Rivaroxaban on Perioperative Complications of Catheter Ablation for Atrial Fibrillation　- Another Analysis of the JACRE-R Registry.

BACKGROUND: The JACRE-R Registry, in which 42 Japanese institutions participated, monitored the efficacy and safety of rivaroxaban in catheter ablation (CA) of atrial fibrillation (AF). In the present analysis, we sought to elucidate the effects and risks of heparin bridging and different patterns of interruption/resumption of rivaroxaban on complications of CA.Methods and Results:We administered rivaroxaban during the perioperative period and recorded the incidence of complications up to 30 days after CA. A total of 1,118 patients were registered; 546 received heparin bridging and 572 did not. The bridging group showed a significantly higher incidence of non-major bleeding than the no-bridging group (4.03% vs. 0.87%; P=0.001). In the group receiving their last dose of rivaroxaban at 8-28 h before CA, neither thromboembolism nor major bleeding was observed during or after CA and the incidence of non-major bleeding was low (4/435, 0.92%). The incidence of non-major bleeding was significantly higher in the group resuming rivaroxaban ≥12 h after CA than in the group resuming <12 h (1.79% vs. 0.27%, P=0.045). CONCLUSIONS: Heparin bridging increased the risk of non-major bleeding perioperatively. It was safe to stop rivaroxaban 8-28 h before the CA procedure, whereas resumption of the drug within 12 h of CA was associated with a lower incidence of non-major bleeding.