Varunsiri Atti1, Mohit K Turagam2, Juan F Viles-Gonzalez3, Dhanunjaya Lakkireddy4. 1. Michigan State University-Sparrow Hospital, East Lansing, MI. 2. Helmsley Electrophysiology Center, Icahn School of medicine at Mount Sinai, New York City, NY. 3. Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA. 4. Kansas City Heart Rhythm Institute, Kansas City, KS.
Abstract
BACKGROUND: Catheter ablation is an effective strategy for treatment of drug-refractory atrial fibrillation (AF). Continuation of oral anticoagulation (OAC) beyond 3 months after an apparently 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 an apparent successful ablation of AF among patients with CHA2DS2VASC or CHADS2 score ≥2were included. Clinical outcomes included cerebrovascular events, systemic thromboembolism and major bleeding. Risk ratios (RR) and 95% confidence intervals for above outcomes were calculated. RESULTS: Nine observational studies were eligible and included 3,436patients of whom 1,815 continued OACs and1,621 discontinued OAC post -AF ablation. There was no significant difference in risk of cerebrovascular events (RR: 0.85, 95%CI: 0.42 to 1.70, p= 0.64)and systemic thromboembolism (RR: 1.21, 95%CI: 0.66 to 2.23, p= 0.54)between the two groups. Continuation of OACs was associated with an increased risk of major bleeding (RR: 6.50, 95% CI: 2.53 to 16.74, p= 0.0001). CONCLUSION: In conclusion, discontinuation of oral anticoagulation 3 months after a successful AF ablation appears to be safe in highly selected closely monitored patients. Further randomized trials are warranted to assess the safety of discontinuing OACs after AF ablation.
BACKGROUND: Catheter ablation is an effective strategy for treatment of drug-refractory atrial fibrillation (AF). Continuation of oral anticoagulation (OAC) beyond 3 months after an apparently 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 an apparent successful ablation of AF among patients with CHA2DS2VASC or CHADS2 score ≥2were included. Clinical outcomes included cerebrovascular events, systemic thromboembolism and major bleeding. Risk ratios (RR) and 95% confidence intervals for above outcomes were calculated. RESULTS: Nine observational studies were eligible and included 3,436patients of whom 1,815 continued OACs and1,621 discontinued OAC post -AF ablation. There was no significant difference in risk of cerebrovascular events (RR: 0.85, 95%CI: 0.42 to 1.70, p= 0.64)and systemic thromboembolism (RR: 1.21, 95%CI: 0.66 to 2.23, p= 0.54)between the two groups. Continuation of OACs was associated with an increased risk of major bleeding (RR: 6.50, 95% CI: 2.53 to 16.74, p= 0.0001). CONCLUSION: In conclusion, discontinuation of oral anticoagulation 3 months after a successful AF ablation appears to be safe in highly selected closely monitored patients. Further randomized trials are warranted to assess the safety of discontinuing OACs after AF ablation.
Authors: Sakis Themistoclakis; Andrea Corrado; Francis E Marchlinski; Pierre Jais; Erica Zado; Antonio Rossillo; Luigi Di Biase; Robert A Schweikert; Walid I Saliba; Rodney Horton; Prasant Mohanty; Dimpi Patel; David J Burkhardt; Oussama M Wazni; Aldo Bonso; David J Callans; Michel Haissaguerre; Antonio Raviele; Andrea Natale Journal: J Am Coll Cardiol Date: 2010-02-23 Impact factor: 24.094
Authors: Michael P Riley; Erica Zado; Mathew D Hutchinson; David Lin; Rupa Bala; Fermin C Garcia; David J Callans; Joshua M Cooper; Ralph J Verdino; Sanjay Dixit; Francis E Marchlinski Journal: J Cardiovasc Electrophysiol Date: 2014-03-10
Authors: Julian P T Higgins; Douglas G Altman; Peter C Gøtzsche; Peter Jüni; David Moher; Andrew D Oxman; Jelena Savovic; Kenneth F Schulz; Laura Weeks; Jonathan A C Sterne Journal: BMJ Date: 2011-10-18
Authors: Roger A Winkle; R Hardwin Mead; Gregory Engel; Melissa H Kong; Rob A Patrawala Journal: J Interv Card Electrophysiol Date: 2013-10-08 Impact factor: 1.900