Purpose We hypothesized that intermittent anticoagulation based on daily rhythm monitoring using the novel oral anticoagulants (NOACs) is feasible and safe among patients with paroxysmal atrial fibrillation (AF). Methods Patients with paroxysmal AF and ≥1 risk factors for stroke were randomized to either intermittent or continuous anticoagulation. Those in the intermittent group were instructed to transmit a daily ECG using an iPhone-based rhythm monitoring device. If AF was detected, patients received one of the NOACs for 48 hours -1 week. Patients who failed to transmit an ECG for 3 consecutive days or more than 7 days total were crossed over to continuous anticoagulation. Patients in the continuous group received one of the NOACs. Results Fifty-eight patients were randomized to either intermittent (n=29) or continuous anticoagulation (n=29). Over a median follow-up of 20 months, 20 patients in the intermittent group failed to submit a daily ECG at least once (median 3 failed submissions). Four patients (14%) crossed over to continuous anticoagulation due to failure to submit an ECG for 3 consecutive days. One stroke (continuous group) occurred during the study. Major bleeding occurred in 2 patients in the continuous and one patient in the intermittent group, after crossing over to continuous anticoagulation. In a pre-specified per-protocol analysis, gastrointestinal bleeding was more frequent in the continuous group (16% vs. 0%; p=0.047). Conclusions Intermittent anticoagulation based on daily rhythm monitoring is feasible and may decrease bleeding in low-risk patients with paroxysmal AF. A larger trial, adequately powered to detect clinical outcomes, is warranted.