The safety of discontinuation of oral anticoagulation therapy after apparently successful atrial fibrillation ablation: a report from the Chinese Atrial Fibrillation Registry study

Abstract

Aims We aimed to investigate the safety of discontinuing oral anticoagulation (OAC) therapy after apparently successful atrial fibrillation (AF) ablation, using data from the Chinese Atrial Fibrillation Registry study. Methods and results We identified 4512 consecutive patients who underwent successful AF ablation between August 2011 and December 2017. Of them, 3149 discontinued OAC 3 months post-ablation (Off-OAC group) and 1363 continued OAC beyond this period (On-OAC group). Regular follow-up examinations were undertaken to detect AF recurrence, monitor OAC therapy, and measure clinical outcomes. Primary outcomes included thromboembolic and major bleeding (MB) events experienced beyond 3 months after ablation. Low thromboembolic and MB event rates were noted in the on-treatment analysis. The incidence rates for thromboembolism were 0.54 [95% confidence interval (CI) 0.39–0.76] and 0.86 (95% CI 0.56–1.30) per 100 patient-years, and that for MB events were 0.19 (95% CI 0.11–0.34) and 0.35 (95% CI 0.18–0.67) per 100 patient-years, for the Off-OAC and On-OAC groups over mean follow-up periods of 24.2 ± 14.7 and 23.0 ± 13.6 months, respectively. Similar results were observed in the intention-to-treat analysis. Previous history of ischaemic stroke (IS)/transient ischaemic attack (TIA)/systemic embolism (SE) [hazard ratio (HR) 3.40, 95% CI 1.92–6.02; P < 0.01] and diabetes mellitus (HR 2.06, 95% CI 1.20–3.55, P = 0.01) were independently associated with thromboembolic events, while OAC discontinuation (HR 0.71, 95% CI 0.41–1.23, P = 0.21) remained insignificant in multivariable analysis. Conclusions This study suggests that it may be safe to discontinue OAC in post-ablation patients under diligent monitoring, in the absence of AF recurrence, history of IS/TIA/SE, and diabetes mellitus. However, further large-scale randomized trials are required to confirm this. Trial registration Chinese Clinical Trial Registry ChiCTR-OCH-13003729. URL: http://www.chictr.org.cn/showproj.aspx?proj=5831.

Reappraisal on pharmacological and mechanical treatments of heart failure

“…CASTLE-AF also discovered that CA was associated with a significantly lower rate of a composite end point of death from any cause or HHF than medical therapy [160]. One study suggested that it may be safe to discontinue oral anticoagulation in post-ablation patients under diligent monitoring, in the absence of AF recurrence, a history of ischaemic stroke/transient ischaemic attack/systemic embolism, and diabetes mellitus [161,162], but evidence is lacking in patients with HF and AF. The choice of optimal treatment strategies for patients with both AF and HF is increasingly difficult, given that results from trials of pharmacological rhythm control are arguably obsolete in the age of CA.…”

Effectiveness of P-wave ECG index and left atrial appendage volume in predicting atrial fibrillation recurrence after first radiofrequency catheter ablation

“…The condition poses a serious threat and adverse impact on the quality of life and the lives of patients [ 1 , 2 ]. Radiofrequency catheter ablation is commonly used to treat atrial fibrillation [ 3 , 4 ], with a success rate as high as 60–90%. However, there is still a risk of recurrence for patients.…”

Discontinuation of oral anticoagulation therapy after successful atrial fibrillation ablation: A systematic review and meta-analysis of prospective studies

“…After a review of titles and abstracts, 2,472 studies were excluded, and the remaining 32 were considered potentially eligible trials and identified by reading the full-text. Finally, a total of 10 studies [12][13][14][15][16][17][18][19][20][21] were included. After screening the reference lists of included articles, we retrieved two potential studies, but neither met our inclusion criteria.…”

“…These studies were published between 2006 and 2020. Among the ten studies included here, four were conducted in the United States [12][13][14]16], two in China [19,20], one in the UK and Australia [21], one in France [18], and one in Italy [17]. The sample size ranged from 108 [16] to 4512 [19] patients.…”

“…The duration of followup across the studies ranged from 1.9 to 5 years. Warfarin as the only anticoagulant drug was prescribed for patients in all but four studies [16,[18][19][20], which included partial patients on direct OACs (DOACs). OAC was discontinued in 7,160 (64.2%) patients.…”