Key result
Monitoring-guided OAC discontinuation after AF ablation linked to ~22% less OAC exposure without major events.
Why the study?
Oral anticoagulation is recommended after AF ablation regardless of arrhythmia control, but discontinuing it in selected patients may be safe.
Does continuous rhythm monitoring-guided oral anticoagulation discontinuation safely reduce OAC exposure in patients following atrial fibrillation ablation?
Observational (n=196)
No
Does continuous rhythm monitoring-guided oral anticoagulation discontinuation safely reduce OAC exposure in patients following atrial fibrillation ablation?
Continuous rhythm monitoring-guided OAC discontinuation after AF ablation safely reduces OAC exposure without increasing thromboembolic or bleeding risks.
Supports monitoring-guided OAC discontinuation after AF ablation; leaves open need for randomized confirmation before practice change.
Introduction Oral anticoagulation (OAC) based on estimated stroke risk is recommended following catheter ablation (CA) of atrial fibrillation (AF), regardless of the extent of arrhythmia control. However, discontinuing OAC in selected patients may be safe. We sought to evaluate a strategy of OAC discontinuation following AF ablation guided by continuous rhythm monitoring. Methods and Results We prospectively studied AF ablations performed at our institution from June 2015 to December 2019. Patients that had pre‐existing cardiac implantable electronic devices (CIEDs) or underwent insertable cardiac monitor (ICM) implantation immediately following AF ablation were included. OAC was continued for 6 weeks following CA in all patients, following which OAC management was guided by CHA 2 DS 2 ‐VASc score and continuous rhythm monitoring results, according to a prespecified protocol. AF recurrence was defined as ≥30 s (CIEDs) or ≥2 min (ICM). We studied 196 patients (mean age 64.7 ± 11.3 years, 66.8% male, 85.7% ICM, 14.3% CIEDs). Mean CHA 2 DS 2‐ VASc score was 2.2 ± 1.5. One‐year AF‐free survival following CA was 83% for paroxysmal AF and 63% for persistent AF patients. Over 3 year follow‐up, OAC was discontinued in 57 (33.7%) patients, mean 7.4 ± 7.1 months following ablation. Following discontinuation, OAC was restarted for AF recurrence in 9 (15.8%) patients, mean 11.7 ± 6.8 months after stopping. This discontinuation protocol led to a 21.9% reduction in overall time exposed to OAC. There were no thromboembolic or major bleeding events. Conclusion OAC can be discontinued in a significant percentage of patients following CA of AF. When guided by continuous rhythm monitoring, this practice does not unacceptably increase the risk of thromboembolic events
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Pothineni et al. (2020) conducted an observational in Atrial fibrillation (n=196). Oral anticoagulation discontinuation guided by continuous rhythm monitoring was evaluated on Thromboembolic or major bleeding events. Oral anticoagulation discontinuation guided by continuous rhythm monitoring after atrial fibrillation ablation reduced OAC exposure time by 21.9% with no thromboembolic or major bleeding events.
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