Very Low Risk of Thromboembolic Events in Patients Undergoing Successful Catheter Ablation of Atrial Fibrillation With a CHADS2 ≤3: A Long Term Outcome Study

Study Questions:

Is it safe to discontinue oral anticoagulation (OAC) therapy after radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF)?

Methods:

RFCA of AF (paroxysmal in 60%) was performed in 327 patients (mean age 63 years, mean CHADS2 score 1.9). All patients were treated with warfarin for ≥3 months post-ablation. Serial 24-hour and 7-day Holter monitors were performed during follow-up. If there was no evidence of AF at 3 months of follow-up, OAC therapy was discontinued regardless of CHADS2 score. In patients with prior thromboembolic complications, OAC therapy was continued for 6-12 months post-ablation. Upon discontinuation of OAC therapy, patients were treated indefinitely with aspirin or clopidogrel. OAC therapy was maintained in patients with recurrent AF.

Results:

The mean duration of follow-up was 46 months. There was freedom from AF in 70% of patients after one ablation procedure and in 82% of patients after two procedures. OAC therapy was discontinued in 91% of patients. There were no symptomatic cerebrovascular ischemic events or systemic emboli during follow-up.

Conclusions:

The authors concluded that after successful RFCA of AF, OAC therapy can be safely discontinued in patients with a CHADS2 score ≤3.

Perspective:

The study shows that there is a very low risk of thromboembolic complications when OAC therapy is discontinued after RFCA of AF in patients at low to moderate risk of stroke as long as appropriate monitoring is performed to rule out symptomatic and asymptomatic recurrences of AF. Very few patients in this study had a CHADS2 score ≥4, and because of the risk of late, asymptomatic recurrences of AF, indefinite OAC therapy would be prudent in high-risk patients.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Outcome Assessment (Health Care), Stroke, Recurrence, Follow-Up Studies, Heart Conduction System, Warfarin, Electrocardiography, Catheter Ablation


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