{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T23:42:13Z","timestamp":1767829333860,"version":"3.49.0"},"reference-count":17,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,12,11]],"date-time":"2020-12-11T00:00:00Z","timestamp":1607644800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Arrhythmia"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The need for pre\u2010 or peri\u2010procedural imaging to rule out the presence of left atrial thrombus in patients undergoing catheter ablation of atrial fibrillation (AF) is unclear in the era of uninterrupted direct oral anticoagulant (DOAC) regimen. We sought to examine the safety of catheter ablation in appropriately selected patients with paroxysmal AF without performing screening for left atrial thrombus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p>Consecutive patients planned for radiofrequency AF catheter ablation between January 2016 and June 2020 were enrolled, and prospectively studied. All subjects were receiving uninterrupted anticoagulation with DOACs for at least 4\u00a0weeks before the procedure. All subjects were in sinus rhythm the day of the procedure. The primary outcome of the study was ischemic stroke or transient ischemic attack (TIA) during at 30\u00a0days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 451 patients (age 59.7\u00a0\u00b1\u00a010.2\u00a0years, 289 males) with paroxysmal AF were included in the study. The mean CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>\u2010VASc score was 1.4\u00a0\u00b1\u00a01.2. The mean left ventricular ejection fraction and left atrial diameter were 60\u00a0\u00b1\u00a05% and 39.3\u00a0\u00b1\u00a04\u00a0mm, respectively. Regarding the anticoagulation regimen, apixaban was used in 197 (43.6%) patients, rivaroxaban in 148 (32.8%) patients, and dabigatran in 106 (23.5%) patients. None of the patients developed clinical ischemic stroke or TIA during the 30\u2010day post\u2010discharged period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Catheter ablation can be safely performed in low\u2010risk patients with paroxysmal AF without imaging for the detection of left atrial thrombus in the era of uninterrupted DOAC anticoagulation.<\/jats:p><\/jats:sec>","DOI":"10.1002\/joa3.12466","type":"journal-article","created":{"date-parts":[[2020,12,12]],"date-time":"2020-12-12T04:59:57Z","timestamp":1607749197000},"page":"28-32","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Safety of catheter ablation of atrial fibrillation without pre\u2010 or peri\u2010procedural imaging for the detection of left atrial thrombus in the era of uninterrupted anticoagulation"],"prefix":"10.1002","volume":"37","author":[{"given":"Michael","family":"Efremidis","sequence":"first","affiliation":[{"name":"Second Department of Cardiology Laboratory of Cardiac Electrophysiology \"Evangelismos\" General Hospital of Athens Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1009-9772","authenticated-orcid":false,"given":"George","family":"Bazoukis","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology Laboratory of Cardiac Electrophysiology \"Evangelismos\" General Hospital of Athens Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konstantinos","family":"Vlachos","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology Laboratory of Cardiac Electrophysiology \"Evangelismos\" General Hospital of Athens Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Efstathia","family":"Prappa","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology Laboratory of Cardiac Electrophysiology \"Evangelismos\" General Hospital of Athens Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Athanasia","family":"Megarisiotou","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology Laboratory of Cardiac Electrophysiology \"Evangelismos\" General Hospital of Athens Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stylianos","family":"Dragasis","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology Laboratory of Cardiac Electrophysiology \"Evangelismos\" General Hospital of Athens Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4350-1652","authenticated-orcid":false,"given":"F. Daniel","family":"Ramirez","sequence":"additional","affiliation":[{"name":"H\u00f4pital Cardiologique du Haut L\u00e9v\u00e8que CHU de Bordeaux and IHU\u2010LIRYC Pessac France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix","family":"Bourier","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology German Heart Center Technical University Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Panagiotis","family":"Mililis","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology Laboratory of Cardiac Electrophysiology \"Evangelismos\" General Hospital of Athens Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Athanasios","family":"Saplaouras","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology Laboratory of Cardiac Electrophysiology \"Evangelismos\" General Hospital of Athens Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5510-1253","authenticated-orcid":false,"given":"Gary","family":"Tse","sequence":"additional","affiliation":[{"name":"Xiamen Cardiovascular Hospital Xiamen University Xiamen People's Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0482-0738","authenticated-orcid":false,"given":"Tong","family":"Liu","sequence":"additional","affiliation":[{"name":"Tianjin Key Laboratory of Ionic\u2010Molecular Function of Cardiovascular Disease Department of Cardiology Tianjin Institute of Cardiology Second Hospital of Tianjin Medical University Tianjin People's Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theodore","family":"Efremidis","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology Laboratory of Cardiac Electrophysiology \"Evangelismos\" General Hospital of Athens Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Panagiotis","family":"Kitsoulis","sequence":"additional","affiliation":[{"name":"Laboratory of Anatomy\u2010Histology\u2010Embryology School of Medicine University of Ioannina Ioannina Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Costas","family":"Thomopoulos","sequence":"additional","affiliation":[{"name":"Department of Cardiology Helena Venizelou Hospital Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonios","family":"Sideris","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology Laboratory of Cardiac Electrophysiology \"Evangelismos\" General Hospital of Athens Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8924-8261","authenticated-orcid":false,"given":"Konstantinos P.","family":"Letsas","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology Laboratory of Cardiac Electrophysiology \"Evangelismos\" General Hospital of Athens Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,12,11]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eux274"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2020.07.017"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2016.03.024"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-018-1333-0"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euq074"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euq456"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv177"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1701005"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euaa015"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2017.09.011"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13763"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1530\/ERP-17-0042"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.006426"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2016.09.011"},{"key":"e_1_2_6_16_1","first-page":"A15938","article-title":"Safety of radiofrequency ablation without pre\u2010procedural trans\u2010esophageal echocardiography in patients with atrial fibrillation on novel oral anticoagulants","volume":"140","author":"Diab M","year":"2019","journal-title":"Circulation"},{"issue":"5","key":"e_1_2_6_17_1","first-page":"1084","article-title":"Practice guidelines for perioperative transesophageal echocardiography. 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