Oral anticoagulation regimens
The following 4 DOACs had been prescribed at least 4 weeks before the ablation: rivaroxaban, apixaban, edoxaban, and dabigatran. The choice of the DOAC was left to the discretion of each referring physician. On the basis of the current guidelines on the use of DOACs [7] or landmark trials [8-10], the standard doses of apixaban, edoxaban, and dabigatran were determined as 5 mg BID, 60 mg OD, and 150 mg BID, respectively. A landmark trial [11] and the guidelines [7] recommend a 20 mg OD as a standard dose for rivaroxaban. However, based on the J-ROCKET AF trial [12] that included only Japanese patients, its Japan-specific standard dose of 15 mg OD predominated in Japan. The rivaroxaban dose was reduced to 10 mg OD if patients had a creatinine clearance of ≤50 ml/min [12]. For apixaban, the reduced dose of 2.5 mg BID was given if patients had 2 of the following 3 factors: age ≥80 years, creatinine ≥1.5 mg/dL, and body weight ≤60 kg [7,8]. Patients received a lower edoxaban dose of 30 mg OD if they had a creatinine clearance of ≤50 ml/min or body weight ≤60 kg [7,9]. To date, there is no pre-specified dose-reduction criteria for dabigatran [7]. In the present study, we considered it an appropriate dose reduction if dabigatran 110 mg BID was prescribed in the patients who were older than 80 years or had a history of massive bleeding [13]. Patients with OD or BID dosing regimens were instructed to take their total or morning dose, respectively, with breakfast. Patients with BID dosing regimens were encouraged to take the evening dose at dinner. On the procedural day, the normal daily dose was not taken until the post-procedural evening in patients with OD dose regimens. The morning dose on the procedural day was skipped, and the evening dose was taken on the post-procedural evening as usual in patients with BID dosing regimens. In the patients prescribed with any antiplatelets, they were withheld for at least 7 days before the procedure. A bridging therapy with heparin was not applied.