Research articles: ArrhythmiasCatheter ablation of atrial fibrillation with uninterrupted anticoagulation: a meta-analysis of six randomized controlled trialsDi Monaco, Antonio∗; Guida, Pietro∗; Vitulano, Nicola; Quadrini, Federico; Troisi, Federica; Langialonga, Tommaso; Grimaldi, MassimoAuthor Information Dipartimento di Cardiologia, Ospedale Generale Regionale ‘F. Miulli’, Bari, Italy Correspondence to Antonio Di Monaco, MD, Dipartimento di Cardiologia, Ospedale Generale Regionale ‘F. Miulli’, Acquaviva delle Fonti, Bari, Italy Tel: +39 3397351594; fax: +39 080758089; e-mail: email@example.com Received 19 October, 2019 Revised 29 November, 2019 Accepted 26 December, 2019 Journal of Cardiovascular Medicine: July 2020 - Volume 21 - Issue 7 - p 483-490 doi: 10.2459/JCM.0000000000000939 Buy Metrics Abstract Aims Uninterrupted anticoagulation is recommended during the ablation of atrial fibrillation. This meta-analysis compared the safety and efficacy of uninterrupted direct oral anticoagulants (DOACs) to uninterrupted vitamin K antagonists (VKAs) during atrial fibrillation ablation. Methods The meta-analysis included eligible randomized controlled trials from 2009 to 2019. Odds ratios (ORs) and 95% confidence intervals were pooled using a random effects model and a sensitivity analysis was performed by sequentially removing one study or DOAC at a time. Results Six studies were included; 1288 received DOAC and 1081 VKA. Pooled ORs indicated a lower nonsignificant incidence in DOACs vs. VKA of composite outcome of major bleeding, stroke, or transient ischemic attack, and mortality (0.69; 0.28–1.71; 31 vs. 45 events), major bleeding alone (0.66; 0.30–1.47; 27 vs. 41 events), and cardiac tamponade (0.56; 0.21–1.45; eight vs. 13 events) with a slightly higher occurrence of minor bleeding (1.17; 0.89–1.56; 139 vs. 106 events) and silent cerebral thromboembolic events (1.12; 0.75–1.66; 72 vs. 58 among 442 and 376 patients performing MRI study). Sensitivity analyses confirmed overall results: pooled ORs ranged from 0.56 to 1.00 for the composite outcome and from 0.54 to 0.92 for major bleedings. Conclusion Uninterrupted DOAC is a safe and effective alternative to uninterrupted VKA during atrial fibrillation ablation. © 2020 Italian Federation of Cardiology - I.F.C. All rights reserved.