Evidence map›Paper›PMID 34333631›Full record

SynthesisEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2021

Meta-analysis of controlled studies on minimally interrupted vs. continuous use of non-vitamin K antagonist oral anticoagulants in catheter ablation for atrial fibrillation.

Stijn P G van Vugt, Sjoerd W Westra, Rick H J A Volleberg, Gerjon Hannink, Rena Nakamura, Carlo de Asmundis, Gian-Battista Chierchia, Eliano P Navarese, Marc A Brouwer

Open access · hybridAbstract readMeta-Analysis
In one paragraph

Synthesis in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 2 pooled it
3.0field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 2 syntheses or guidelines pooled it, 26 citations in OpenAlex.

  1. Guideline
  2. Guideline
  3. Review
  4. Article
  5. 2025 Thai guideline for the diagnosis and management of atrial fibrillation.Asian biomedicine : research, reviews and news · 2025
    Article
  6. Article
  7. Review
  8. Article
  9. Article
  10. Article
  11. Article
  12. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024
    Article
  13. Incidence and predictors of stroke and silent cerebral embolism following very high-power short-duration atrial fibrillation ablation.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023
    Article
  14. Patient selection, peri-procedural management, and ablation techniques for catheter ablation of atrial fibrillation: an EHRA survey.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023
    Article
  15. Rhythm monitoring, success definition, recurrence, and anticoagulation after atrial fibrillation ablation: results from an EHRA survey.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023
    Article
  16. Article
  17. Review
  18. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 5 countries.

Stijn P G van VugtDepartment of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 6101, 6500 HB Nijmegen, the Netherlands.
Sjoerd W WestraDepartment of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 6101, 6500 HB Nijmegen, the Netherlands.ORCID 0000-0003-0165-6151
Rick H J A VollebergDepartment of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 6101, 6500 HB Nijmegen, the Netherlands.
Gerjon HanninkDepartment of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands.
Rena NakamuraHeart Center, Japan Red Cross Yokohama City Bay Hospital, 3-12-1 Shinyamashita, 231-8682 Naka-ku, Yokohama City, Kanagawa Prefecture, Japan.
Carlo de AsmundisHeart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium.
Gian-Battista ChierchiaHeart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium.
Eliano P NavareseDepartment of Cardiology and Internal Medicine, Nicolaus Copernicus University, Antoni Jurasz University Hospital No. 1, Antoniego Jurasza ul. Marii Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland.
Marc A BrouwerDepartment of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 6101, 6500 HB Nijmegen, the Netherlands.
Radboud University Nijmegen · NLUniversitair Ziekenhuis Brussel · BEUniversity of Alberta · CAYokohama Rosai Hospital · JP

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsAt present, there are no guideline recommendations for minimally interrupted use of non-vitamin K antagonist oral anticoagulants (mi-NOAC) during catheter ablation (CA) for atrial fibrillation (AF). Current evidence is predominantly based on observational studies, with continuous use of vitamin K antagonist in the control arm. This quantitative summary reflects the first high-level evidence on contemporary regimens, with continuous NOAC use (c-NOAC) as the current gold standard. METHODS AND

resultsMeta-analysis (Pubmed, Embase, and Web of Science) on prospective, controlled studies comparing contemporary mi-NOAC (without bridging) with c-NOAC. Net adverse clinical events (major bleeding, thrombo-embolic events) were the primary outcome. In addition, we analysed total bleeding, minor bleeding, and silent cerebral embolism. Eight studies (six randomized, two observational) with 2168 patients were summarized. The primary endpoint occurred in 1.0% (18/1835): 1.1% (11/1005) vs. 0.8% (7/830) for the mi-NOAC and c-NOAC groups, respectively; odds ratio (OR) 1.20 [95% confidence interval (CI) 0.49-2.92, P = 0.64]. The OR for total bleeding on mi-NOAC was 1.26 (95% CI 0.97-1.63, P = 0.07). ORs for minor bleeding and silent cerebral embolism were 1.17 (95% CI 0.80-1.70, P = 0.34) and 2.62 (95% CI 0.54-12.61, P = 0.12), respectively.

conclusionThis synopsis provides a quantitative synthesis of high-level evidence on a contemporary strategy of mi-NOAC in CA for AF, and overall clinical outcomes were not different from continuous NOAC use. Despite preprocedural interruption, there was no sign of lower bleeding rates. Additional higher volume datasets are warranted for more precise treatment effect estimations of this everyday alternative anticoagulation strategy in AF ablation.

Indexed as

Atrial FibrillationCatheter AblationStrokeAdministration, OralAnticoagulantsHumansProspective StudiesRandomized Controlled Trials as TopicVitamin KAnticoagulantsVitamin KAtrial fibrillationBleedingCatheter ablationNon-vitamin K antagonist oral anticoagulantsPeriprocedural anticoagulation strategyStroke

Identifiers

PMID34333631
PMCPMC8651164
OpenAlexW3191123453

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.