Post AF Ablation Anticoagulation: Real World Practice and Predictors of Therapy

Background Oral anticoagulation (OAC) is recommended for ≥3 months post catheter ablation (CA) for atrial fibrillation (AF) and indefinitely in higher risk patients. Current practice and associated predictors are unknown. Objective Report current OAC practice among patients after AF ablation and identify features predictive of OAC therapy post ablation. Methods Patients with AF who underwent CA Jan 1,2017, to Oct 1, 2023, were identified from Optum's Clinformatics® Data Mart and stratified by CHA 2 DS 2 -VASc score into 4 groups. OAC treatment was assessed at 30- and 365-days post CA. Automated machine learning was used to predict OAC use within 1-year after CA based on demographic and clinical information; area under the receiver operating curve (AUROC) was reported. Results We included 65,020 patients (mean age 69; 39% female) with mean CHA 2 DS 2 -VASc score 4.16±2.03. OAC continuation fell steadily over the year after CA especially among lower risk patients. In approximately 10-20% of patients, OAC was not prescribed at the time of ablation or after across all risk groups. The AUROC for the total AF population was 0.607 (95% confidence interval [CI] 0.587 - 0.614). Main predictors for OAC discontinuation at 1-year were lower CHA 2 DS 2 -VASc baseline score (w, 0.033), left atrial appendage occlusion (LAAO) post-CA (w, 0.018), and bleeding event in the follow-up period (w, 0.010), and. Conclusion Discordant with guidelines recommendations, OAC discontinuation was common among patients with AF and at least moderate stroke risk. Stroke risk, LAAO, and bleeding experience were the strongest determinants of OAC discontinuation but did not explain much of the discontinuation.