Anticoagulation After Catheter Ablation of Atrial Fibrillation: Is it time to Discontinue in Select Patient Population?

Abstract

Background: Catheter ablation is an effective strategy for treatment of drug-refractory atrial fibrillation (AF). Continuation of oral anticoagulation (OAC) beyond 3 months after an apparently successful ablation of AF remains controversial. Methods: A systematic electronic search of the scientific literature was performed in PubMed, EMBASE, SCOPUS and Google Scholar. Studies comparing continuation vs discontinuation of OACs after an apparent successful ablation of AF among patients with CHA2DS2VASC or CHADS2 score ≥2were included. Clinical outcomes included cerebrovascular events, systemic thromboembolism and major bleeding. Risk ratios (RR) and 95% confidence intervals for above outcomes were calculated. Results: Nine observational studies were eligible and included 3,436patients of whom 1,815 continued OACs and1,621 discontinued OAC post-AF ablation. There was no significant difference in risk of cerebrovascular events (RR: 0.85, 95%CI: 0.42 to 1.70, p= 0.64) and systemic thromboembolism (RR: 1.21, 95%CI: 0.66 to 2.23, p= 0.54)between the two groups. Continuation of OACs was associated with an increased risk of major bleeding (RR: 6.50, 95% CI: 2.53 to 16.74, p= 0.0001). Conclusions: In conclusion, discontinuation of oral anticoagulation 3 months after a successful AF ablation appears to be safe in highly selected closely monitored patients. Further randomized trials are warranted to assess the safety of discontinuing OACs after AF ablation.

Real-World Investigation on Anticoagulation Management Before and After Catheter Ablation for Atrial Fibrillation in Japan ― Periprocedural and Long-Term Outcomes ―

“…A meta-analysis of 3,436 patients examined the controversial practice of discontinuing OAC therapy after CA in high-risk patients with a CHADS2 or CHA2DS2-VASc score of ≥2. 39 The pooled analysis revealed no significant differences between patients who continued or discontinued OAC therapy regarding the risk of stroke or SEEs, although OAC continuation was associated with an increased risk of major bleeding.…”

Rhythm monitoring, success definition, recurrence, and anticoagulation after atrial fibrillation ablation: results from an EHRA survey

“…From observational retrospective studies, there is weak evidence to show that successful ablation may reduce the risk of cerebrovascular embolic events, thus allowing the cessation of OAC. 24 This risk reduction may be especially true for patients with a low CHA 2 DS 2 -VASc score, and access to continuous monitoring. 25 , 26 Accordingly, our respondents showed a tendency to terminate OAC in patients with paroxysmal AF and a low CHA 2 DS 2 -VASc score.…”

Real-world investigation on discontinuation of oral anticoagulation after paroxysmal atrial fibrillation catheter ablation in China

“…Guidelines or expert's consensus of nowadays is based on evidence derived from researches conducted out of China, especially mainland (14,15). Therefore, there possibly exists a racial difference between patients from China and patients from other countries especially from Europe and America.…”