Discontinuation of Oral Anticoagulation After Successful Catheter Ablation for Atrial Fibrillation: Meta-analysis of Randomized Clinical Trials

Background: Current guidelines recommend indefinite oral anticoagulant (OAC) therapy for atrial fibrillation (AF) patients with stroke risk factors, regardless of catheter ablation (CA) outcomes. However, these recommendations are largely based on non-randomized evidence, and the long-term anticoagulation strategy for patients after successful CA for AF remains uncertain. Objective: To evaluate the efficacy and safety of discontinuing OAC vs. continuing OAC in AF with successful CA. Methods: We searched PubMed, Embase, and major conference proceedings from inception to November 2025, to identify eligible randomized controlled trials (RCTs). Pooled effect estimates were calculated as risk differences (RDs) with 95% corresponding confidence intervals (CIs). Results: A total of 2,324 patients were included across three RCTs, with the mean age ranged from 63 to 67 years, 71.4% were men, and the average CHA2DS2-VASc score was approximately 2. Among patients with successful CA, OAC discontinuation was not associated with a significant increase in the risks of stroke, ischemic stroke, stroke or systemic embolism, transient ischemic attack, and all-cause death. In contrast, continued OAC was associated with significantly higher risks of major bleeding (RD 1.0%, 95% CI 0.2%–1.7%), intracranial bleeding (RD 0.6%, 95% CI 0.2%–1.7%), minor bleeding (RD 2.2%, 95% CI 0.2%–4.1%), and clinically relevant non-major bleeding (RD 2.5%, 95% CI 1.2%–3.9%). No statistically significant difference was observed in gastrointestinal bleeding between groups. Conclusions: In patients with AF and baseline stroke risk who achieve successful CA, discontinuation of OAC therapy does not increase the incidence of thromboembolic events while conferring a substantial reduction in bleeding complications.