Arrhythmias & electrophysiologyRandomised controlled trial
Antithrombotic Therapy after Successful Catheter Ablation for Atrial Fibrillation
- Randomised controlled trial
- international
- open-label
- blinded outcome assessment
Authors' conclusion
Among patients who had had successful catheter ablation for atrial fibrillation at least 1 year earlier and had risk factors for stroke, treatment with rivaroxaban did not result in a significantly lower incidence of a composite of stroke, systemic embolism, or new covert embolic stroke than treatment with aspirin.
Study context
- Population
- Patients with successful catheter ablation for AF ≥1 year earlier and CHA2DS2-VASc ≥1 (≥2 for women or vascular disease)
- Participants
- 1,284 patients
- Comparison
- Rivaroxaban vs aspirin
- Rivaroxabann = 641
- Aspirinn = 643reference
- Primary endpoint
- Stroke, systemic embolism or new covert embolic stroke (≥1 new infarct ≥15 mm on magnetic resonance imaging (MRI))
- Follow-up
- 3 years
Primary result
As reported in the abstract
Rivaroxaban
5
events
Aspirin
9
events
Each group vs aspirinRelative risk (95% CI)
Rivaroxaban
0.56(0.19–1.65)
Each group vs aspirinAbsolute risk difference at 3 years, percentage points (95% CI)P value
Rivaroxaban
−0.6(−1.8 to 0.5)
P = 0.28Further findings
| Outcome | Rivaroxaban | Aspirin | RR (95% CI) | |
|---|---|---|---|---|
| New cerebral infarcts <15 mm · 22 of 568 vs 26 of 590 | 3.9% | 4.4% | 0.89 (0.51–1.55) | |
| 0.512Relative risk (log scale) |
Safety
| Outcome | Rivaroxaban | Aspirin | HR (95% CI) | |
|---|---|---|---|---|
| Fatal or major bleeding (primary safety outcome) · 3 years | 1.6% | 0.6% | 2.51 (0.79–7.95) | |
| 0.10.31310Hazard ratio (log scale) |
Original publication
Antithrombotic Therapy after Successful Catheter Ablation for Atrial Fibrillation. N Engl J Med. Published 8 November 2025. doi:10.1056/nejmoa2509688
Summarised from the published abstract; every number is checked against it