Very Low Risk of Thromboembolic Events in Patients Undergoing Successful Catheter Ablation of Atrial Fibrillation with a CHADS2 <=3: A Long Term Outcome Study.
Circ Arrhythm Electrophysiol. 2011 Aug 13;
Authors: Saad EB, d'Avila A, Costa IP, Aryana A, Slater C, Costa RE, Inácio LA, Maldonado P, Neto DM, Camiletti A, Camanho LE, Polanczyk CA
BACKGROUND: -Long term cessation of oral anticoagulation (OAC) following catheter ablation of atrial fibrillation (AF) has been deemed controversial. The safety of this management strategy in patients without recurrent AF, with historically elevated risks for thromboembolism, remains largely unknown. In this study, we sought to evaluate the long term results of OAC cessation following successful catheter ablation of AF. METHODS AND RESULTS: -OAC and antiarrhythmic drugs (AADs) were discontinued irrespective of AF type or baseline CHADS(2) risk score in 327 patients (mean age: 63 ± 13 years, 79% males) with drug-refractory AF following catheter ablation (mean CHADS2 score: 1.89 ± 0.95; median: 2.0). Patients with a CHADS(2) score of 2 (45.4%) and 3 (23.2%) accounted for 68.8% of this cohort. In patients with high risk of recurrence or prior thromboembolic complications, OAC was continued for up to 6-12 months post-ablation, while antiplatelet therapy was administered to all other patients who maintained sinus rhythm. After a follow up of 46 ± 17 months (range: 13-82) 82% remained AF-free (off AADs). Significant predictors of late AF recurrence (p<0.05) were non-paroxysmal AF (HR: 1.83), female gender (HR: 2.19), age ?60 years (HR: 1.81), LA size >40mm (HR: 3.52), CHADS(2) ? 2 (HR: 1.81) and early recurrences (HR: 5.52). No symptomatic ischemic cerebrovascular events were detected during follow-up despite interruption of OAC in 298 patients (91%) and AADs in 293 patients (89%). CONCLUSIONS: -No significant thromboembolic-related morbidity is observed when AADs and OAC are discontinued following successful catheter ablation of AF in patients with a CHADS(2) score ?3 maintained on antiplatelet therapy during long term follow-up.
PMID: 21841192 [PubMed - as supplied by publisher]