Thromboembolic Risk of Cessation of Oral Anticoagulation Post Catheter Ablation in Patients With and Without Atrial Fibrillation Recurrence

Rong, Bing; Han, Wenqiang; Lin, Mingjie; Li, Hao; Zhang, Kai; Chen, Tongshuai; Sha, Rina; Wang, Juntao; Wang, Rong; Zhong, Jingquan

doi:10.1016/j.amjcard.2020.09.036

Cited by 6 publications

(8 citation statements)

References 23 publications

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“…CA is an effective modality to restore sinus rhythm in AF. Several non-randomized studies, including ours, have found that the incidence of embolism in patients with sinus rhythm after CA is lower than patients experiencing recurrence [ 15 , 38 ]. The evidence reported in the present study showed that CA increased the LAAFV and improved the thrombus formation matrix, which may be one of the mechanisms that reduced embolic events.…”

Section: Discussionmentioning

confidence: 96%

“…After CA, patients routinely took antiarrhythmic drugs, namely oral propafenone 0.45 g/day or amiodarone 0.2 g/day, and oral anticoagulants during the observational period (3 months); continuous anticoagulants was recommended for patients with a history of embolic events or recurrence of atrial tachyarrhythmia [ 15 ]. Antiarrhythmic drugs were managed according to the patients’ conditions and their individual decision.…”

Section: Methodsmentioning

confidence: 99%

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The risk factors of thrombus formation and the effect of catheter ablation on repetitive thrombus formation in patients with atrial fibrillation: a single center retrospective study in China

Liu

Lin

Han

et al. 2023

BMC Cardiovasc Disord

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Background Atrial fibrillation (AF) predisposes patients to the formation of atrial thrombi. The CHA2DS2-VASc score does not include all risk factors for atrial thrombosis. The present study is designed to explore the influencing factors of thrombus formation in patients with AF and to investigate the effect of catheter ablation (CA) on recurrent thrombosis in patients with a history of intracardiac thrombus. Methods (1) This study consisted of 1726 patients that underwent CA, among which 58 patients had a history of intracardiac thrombus prior to CA. The risk factors for thrombus formation were explored by comparing the baseline clinical characteristics of patients with and without atrial thrombus. (2) The left atrial appendage flow velocity (LAAFV) in patients with a history of intracardiac thrombus who were willing to undergo transesophageal echocardiography (TEE) at the latest follow-up were examined, and comparisons of the LAAFV was made before and after CA. Results The median follow-up period is 13 months. Persistent AF was found to be the only independent risk factor affecting the formation of atrial thrombus among the investigated factors (OR 3.152; 95%CI 1.806–5.500; p < 0.001). Twenty-seven patients agreed to undergo TEE during follow-up, no clinical ischemic stroke events were recorded, no recurrent intracardiac thrombus formation was detected in patients, 15 patients maintained sinus rhythm (55.6%) during follow-up; successful CA significantly increased LAAFV (difference between latest evaluation prior to CA 17.46 ± 14.81 cm/s, p < 0.001). Conclusions Persistent AF is the only independent risk factor for thrombus formation. Successful CA may improve the LAAFV and thereby decrease the risk of intracardiac thrombus formation.

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Section: Discussionmentioning

confidence: 96%

Section: Methodsmentioning

confidence: 99%

The risk factors of thrombus formation and the effect of catheter ablation on repetitive thrombus formation in patients with atrial fibrillation: a single center retrospective study in China

Liu

Lin

Han

et al. 2023

BMC Cardiovasc Disord

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“…In addition, a long-term use of OAC or cessation of OAC after 3 months post-ablation remains controversial ( 46 , 47 ). In our previous study, we concluded that cessation of OAC in non-recurrent AF may be reasonable; however, cessation appeared unsafe in recurrent AF with a high thromboembolism risk ( 10 ). With the help of the prediction model, patients at a high risk of recurrence could be identified after catheter ablation, allowing us to monitor these patients closely and encourage them to continue OAC.…”

Section: Discussionmentioning

confidence: 99%

“…According to several studies, both individuals with and without an AF recurrence have a different chance of developing thromboembolism ( 7 – 10 ). Nevertheless, AF recurrence is usually asymptomatic ( 11 ), causing an unawareness of the episode in a considerable number of patients.…”

Section: Introductionmentioning

confidence: 99%

A prediction model of atrial fibrillation recurrence after first catheter ablation by a nomogram: HASBLP score

Han

Liu²,

Sha³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundAt present, catheter ablation is an effective method for rhythm control in patients with atrial fibrillation (AF). However, AF recurrence is an inevitable problem after catheter ablation. To identify patients who are prone to relapse, we developed a predictive model that allows clinicians to closely monitor these patients and treat them with different personalized treatment plans.Materials and methodsA total of 1,065 patients who underwent AF catheter ablation between January 2015 and December 2018 were consecutively included in this study, which examines the results of a 2-year follow-up. Patients with AF were divided into development cohort and validation cohort. Univariate and multivariate analyses were carried out on the potential risk factors. Specific risk factors were used to draw the nomogram according to the above results. Finally, we verified the performance of our model compared with CHADS2 and CHA2DS2-Vasc scores by receiver operating characteristic (ROC) curve and calibration curve and plotted the decision analysis curve (DAC).ResultsA total of 316 patients experienced AF recurrence. After univariate and multivariate analyses, AF history (H), age (A), snoring (S), body mass index (BMI) (B), anteroposterior diameter of left atrial (LA) (L), and persistent AF (P) were included in our prediction model. Our model showed a better performance compared with CHADS2 and CHA2DS2-Vasc scores, and the area under ROC curve (95%CI) was 0.7668 (0.7298–0.8037) vs. 0.6225 (0.5783–0.6666) and 0.6267 (0.5836–0.6717).ConclusionWe established a nomogram (HASBLP score) for predicting AF recurrence after the first catheter ablation at a 2-year follow-up, which can be used as a tool to guide future follow-up of patients. However, its usefulness needs further validation.

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“…They postulated that OAC discontinuation is unsafe in patients with recurrent AF and a high-risk stroke profile due to the high incidence rate of thromboembolism. 55 …”

Section: Discussionmentioning

confidence: 99%

Benefits and Risks Associated with Long-term Oral Anticoagulation after Successful Atrial Fibrillation Catheter Ablation: Systematic Review and Meta-analysis

Maduray

Moneruzzaman

Changwe³

et al. 2022

Clin Appl Thromb Hemost

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Oral anticoagulation (OAC) prevents thromboembolism yet greatly increases the risk of bleeding, inciting concern among clinicians. Current guidelines lack sufficient evidence supporting long-term OAC following successful atrial fibrillation catheter ablation (CA). A literature search was performed in PubMed, Google Scholar, Medline, and Scopus to seek out studies that compare continued and discontinued anticoagulation in post-ablation Atrial fibrillation (AF) patients. Funnel plots and Egger’s test examined potential bias. Via the random-effects model, summary odds ratios (OR) with 95% confidence intervals (CI) were calculated using RevMan (5.4) and STATA (17.0). Twenty studies, including 22 429 patients (13 505 off-OAC) were analyzed. Stratified CHA2DS2-VASc score ≥2 examining thromboembolic events (TE) favored OAC continuation (OR 1.86; 95% CI: 1.02-3.40; P = .04). Sensitivity analysis demonstrated this association was attenuated. The on-OAC arm had greater incidence of major bleeding (MB) (OR 0.16; 95% CI: 0.08-0.95; P < .00001), particularly intracranial hemorrhage (ICH) and gastrointestinal bleeding (GI); (OR 0.17; 95% CI: 0.08-0.36; P < .00001) and (OR 0.12; 95% CI: 0.04-0.32; P < .0001), respectively. Our findings support sustained anticoagulation in patients with a CHA2DS2-VASc score of ≥2. Due to reduced outcome robustness, physician discretion is still advised.

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Thromboembolic Risk of Cessation of Oral Anticoagulation Post Catheter Ablation in Patients With and Without Atrial Fibrillation Recurrence

Cited by 6 publications

References 23 publications

The risk factors of thrombus formation and the effect of catheter ablation on repetitive thrombus formation in patients with atrial fibrillation: a single center retrospective study in China

The risk factors of thrombus formation and the effect of catheter ablation on repetitive thrombus formation in patients with atrial fibrillation: a single center retrospective study in China

A prediction model of atrial fibrillation recurrence after first catheter ablation by a nomogram: HASBLP score

Benefits and Risks Associated with Long-term Oral Anticoagulation after Successful Atrial Fibrillation Catheter Ablation: Systematic Review and Meta-analysis

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