Withdrawal of oral anticoagulants 3 months after successful radiofrequency catheter ablation in patients with atrial fibrillation: A meta‐analysis

Background The best anticoagulation therapy for atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA) remains a challenge. Methods A systematic search of PubMed, Ovid, and Cochrane Library was conducted identifying at clinical trials which evaluated the differences between thromboembolism (TE) and hemorrhage in an off‐oral anticoagulants (OACs) treatment group (the observation group) and an on‐OACs treatment group (the control group), at 3 months after successful RFCA. Meta‐analysis was performed using RevMan 5.3 software, and the fixed effect model was used as a relevant statistical model. χ 2 test and I 2 were used to test for the presence of heterogeneity. Subgroup analysis and sensitivity analysis were also performed. Results The results showed no significant differences between two groups in TE (relative risk [RR] 0.82, 95% confidence interval [CI], 0.51–1.33, P = 0.42), and only mild heterogeneity (P = 0.22, I 2 = 29%). No significant differences in TE between two subgroups were found according to < 3 years and ≥ 3 years follow‐up analyses (RR 0.58, 95% CI, 0.26–1.28, P = 0.18; RR 1.00, 95% CI, 0.54–1.85, P = 1.00). Furthermore, there was a lower risk of TE in the observation subgroup (< 60 years) compared to the control group (RR 0.31, 95% CI, 0.12–0.78, P = 0.01). Also, there were no significant differences in TE between two subgroups (≥ 60 years, RR 1.24, 95% CI, 0.67–2.28, P = 0.49 ) . The risk of hemorrhage in the observation group was significantly lower compared to the control group (RR 0.05, 95%CI, 0.02–0.14, P < 0.00001). Conclusions The withdrawal of OACs 3 months after successful radiofrequency catheter ablation for patients with AF may be safe and feasible. It needs to be tested by randomized controlled trial.