Key result
Stopping OAC after successful surgical AF ablation shows no difference in survival or MACCE versus continuation.
Why the study?
Deciding whether to continue oral anticoagulation therapy after successful surgical AF ablation is challenging, and current guidelines lack specific recommendations on whether discontinuation is safe.
Does discontinuation of oral anticoagulation therapy affect survival or MACCE in patients with successful surgical ablation of atrial fibrillation and CHADS2 score ≤2?
Cohort (n=436)
No
Does discontinuation of oral anticoagulation therapy affect survival or MACCE in patients with successful surgical ablation of atrial fibrillation and CHADS2 score ≤2?
Discontinuation of oral anticoagulation appears safe in patients with a CHADS2 score ≤2 following successful surgical ablation of atrial fibrillation and left atrial appendage occlusion.
No difference in survival or MACCE with OAC discontinuation; leaves open safety in low-risk patients pending randomized trials.
Background The decision of whether to continue oral anticoagulation therapy (OAT) after successful surgical ablation of atrial fibrillation is challenging, and current guidelines provide no specific recommendations on whether or not it is safe to terminate OAT. Therefore, the aim of this study was to assess long-term outcomes in patients who either did or did not, receive OAT after surgical ablation of atrial fibrillation. Methods In a prospective follow-up study, patients were included if surgical ablation of atrial fibrillation concomitantly with other cardiac surgery was done, between 2004 and 2018 at Aarhus University Hospital, Denmark. After 12 months, OAT was discontinued if: (a) sinus rhythm was documented by electrocardiogram, (b) atrial fibrillation was absent on 5-day Holter monitoring, (c) CHADS2 score ≤2, and (d) no other indications for OAT were present. Follow-up was ended in April 2019. Results A total of 560 patients underwent surgical ablation of which 436 patients reached the baseline at 12 months; 286 patients received OAT, and 150 had OAT discontinued. Survival analysis revealed no differences between the two groups (P = .723). Mean survival time in the group receiving OAT was 5.3 ± 3.3 years, compared to 5.1 ± 3.0 years in the group where OAT was discontinued (P = .784). There was no difference in major adverse cardiac and cerebrovascular events between the two groups (P = .846). Conclusion Discontinuation of OAT is safe in patients with a CHADS2 score ≤2 following successful surgical ablation and left atrial appendage occlusion. This conclusion needs to be confirmed in randomized trials.
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Lauritzen et al. (2020) conducted a cohort in Atrial fibrillation (n=436). Discontinuation of oral anticoagulation therapy vs. Continuation of oral anticoagulation therapy was evaluated on Survival (p=.723). Discontinuation of oral anticoagulation therapy after successful surgical ablation of atrial fibrillation showed no difference in survival (P=0.723) or major adverse cardiac and cerebrovascular events (P=0.846) compared to continuation.
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