Key result
In patients with severely enlarged left atria and previous AF ablation, ECG alone may be unreliable for guiding OAC cessation, and echocardiographic assessment of atrial contractility is recommended.
Why the study?
Does echocardiographic assessment of atrial contractility improve the safety of oral anticoagulation cessation compared to an ECG-guided approach in patients with successful atrial fibrillation ablation?
Does echocardiographic assessment of atrial contractility improve the safety of oral anticoagulation cessation compared to an ECG-guided approach in patients with successful atrial fibrillation ablation?
Echocardiographic assessment of atrial contractility may be necessary before stopping oral anticoagulation after successful AF ablation, as ECG-guided approaches alone may be insufficient in high-risk patients.
Caution against ECG-only OAC decisions post-ablation in enlarged atria; hypothesis-generating for echo-guided strategies.
INTRODUCTION: Long-term cessation of oral anticoagulation (OAC) following successful catheter or surgical ablation of atrial fibrillation (AF) is debated. Usually, in the presence of sinus rhythm at serial ECG recordings, the CHADS2, CHA2DS2VASc, and HAS-BLED scores are adopted to guide decision regarding OAC management. Areas covered: The safety of OAC cessation in patients without recurrent AF but with historically elevated risk for thromboembolism remains largely unknown. Taking the cue from two clinical cases, we provide an updated summary of the latest evidence regarding how to manage OAC after a successful atrial fibrillation ablation. Expert commentary: The present clinical perspective suggests that, at least within patients with severely enlarged left atrium, previous cardiac surgery and catheter or surgical AF ablation, especially if repeated, assessment of atrial contractility by transthoracic echocardiography should be performed before discontinuing OAC in patients who maintain sinus rhythm, confirmed by serial ECG or Holter monitorings.
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Anselmino et al. (2017) conducted a review in Atrial fibrillation (n=2). Echocardiographic assessment of atrial contractility vs. ECG-guided approach was evaluated. In patients with severely enlarged left atria and previous AF ablation, ECG alone may be unreliable for guiding OAC cessation, and echocardiographic assessment of atrial contractility is recommended.
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