Discontinuation of oral anticoagulation therapy after apparently successful atrial fibrillation ablation

We found the study by Yang et al.1 regarding discontinuation of oral anticoagulation (OAC) therapy after apparently successful atrial fibrillation (AF) ablation very interesting. We believe that it is important to analyse and report whether to continue OAC therapy after apparently successful AF ablation. Studies showed that both adjusted-dose warfarin and new oral anticoagulants reduce stroke in patients with AF. However, it is not clear whether OAC therapy should be continued after apparently successful AF ablation, even in the latest guideline.2 This study identified 4512 consecutive patients who underwent successful AF ablation to suggest that it may be safe to discontinue OAC in post-ablation patients under diligent monitoring, in the absence of AF recurrence, history of ischaemic stroke/transient ischaemic attack/systemic embolism, and diabetes mellitus.1 But there are a few things we need to pay attention to. First, less than half of the patients in the Off-OAC group and the On-OAC group received 24 h Holter monitoring regularly (41.9% and 42.0%, respectively), which obviously missed a large part of the findings of AF, particularly, paroxysmal AF. What is more, all cancers increase developing thromboembolic risk,3 cancer complications may also need to be considered. Third, old age and left atrial enlargement is suitable and significant risk factor for thromboembolic events in patients with AF,4,5 almost half of the population included in this study were elderly (46.1% in the Off-OAC group and 51.6% in the On-OAC group, respectively) and left atrial enlargement [left atrial diameter >40 mm, 1436 (48.7%) in the Off-OAC group and 697 (55.0%) in the On-OAC group, respectively). There are differences at baseline, and we need to be careful when drawing conclusions, although intention-to-treat analysis was conducted. Finally, this is a prospective registry study involving 31 tertiary and non-tertiary hospitals, however, in Beijing, China, that is to say, a report from the Chinese real-word AF registry study. We need evidence from many countries to further confirm this. This work was funded by National Natural Science Foundation of China [81774229], Jiangsu Leading Talent Project of Traditional Chinese Medicine, Jiangsu Science and Technology Department Project [BK20161115], Major Project of Nanjing Medical Science and Technology Development During the 13th Five-year Plan [ZDX16013], and Jiangsu Universities Nursing Advantage Discipline Project [2019YSHL095]. Conflict of interest: none declared.