Is There a Need to Continue Anticoagulation Following “Successful” Atrial Fibrillation Ablation?

Atrial fibrillation (AF) is the most common clinically significant arrhythmia worldwide, and its incidence is increasing. There has been increasing interest in ablation therapy to treat atrial fibrillation. One reason some patients undergo AF ablation might be to obviate the need for warfarin therapy, although current guidelines do not support this rationale. The current review shows that it is difficult to define a true "cure" postablation, as many of these patients will go on to experience future paroxysms of AF (either symptomatic or silent). The mechanism underlying embolism in patients with AF is not completely understood, and no long-term evidence exists that "successfully ablated" patients return to a baseline risk of stroke comparable to an AF-naive population. The authors recommend continued long-term anticoagulation post-AF ablation in patients satisfying CHADS criteria for elevated stroke risk.