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Anticoagulation After Catheter Ablation of Atrial Fibrillation: Is it Time to Discontinue in Select Patient Population?

Background: Catheter ablation is an effective strategy for treatment of drug refractory atrial fibrillation (AF). Continuation of oral anticoagulation (OAC) after an apparent successful ablation of AF remains controversial. Methods: A systematic electronic search of the scientific literature was performed in PubMed, EMBASE, SCOPUS and Google Scholar. Studies comparing continuation vs discontinuation of OACs after AF ablation in patients with CHA2DS2VASC score≥ 2 were included. Results: Five observational studies were eligible and included 1,517 patients of whom 839 continued OACs and 678 discontinued OAC post AF ablation. There was no significant difference in risk of cerebrovascular events (CVA) and systemic thromboembolism between the two groups. Continuation of OACs was associated with an increased risk of major bleeding (OR: 11.51, 95% CI: 3.16 to 41.93, p= 0.0002) and trend towards higher risk of gastrointestinal bleeding (OR: 4.62, 95% CI: 0.80 to 26.69, p= 0.09). Conclusion: Our results suggest that there was no difference in the risk of CVA and thromboembolic events between continuation of OACs versus their discontinuation. Continuation of OACs was associated with an increased risk of bleeding.

Credits: Varunsiri Atti, MD, Mohit K Turagam, MD, Juan F. Viles-Gonzalez, MD, Dhanunjaya Lakkireddy, MD

Biosense Webster
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Introduction to AFib
Ablation Specialist

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