TY - JOUR
T1 - The Risk of Thromboembolism and Need for Oral Anticoagulation After Successful Atrial Fibrillation Ablation
AU - Themistoclakis, Sakis
AU - Corrado, Andrea
AU - Marchlinski, Francis E.
AU - Jais, Pierre
AU - Zado, Erica
AU - Rossillo, Antonio
AU - Di Biase, Luigi
AU - Schweikert, Robert A.
AU - Saliba, Walid I.
AU - Horton, Rodney
AU - Mohanty, Prasant
AU - Patel, Dimpi
AU - Burkhardt, David J.
AU - Wazni, Oussama M.
AU - Bonso, Aldo
AU - Callans, David J.
AU - Haissaguerre, Michel
AU - Raviele, Antonio
AU - Natale, Andrea
N1 - Funding Information:
Dr. Jaïs has received presentation fees from BW/Bard. Dr. Schweikert has received speaker honoraria from GlaxoSmithKline, Sanofi-Aventis, St. Jude Medical, and Boston Scientific. Dr. Saliba has received speaker honoraria from J&J, Medtronic, St. Jude Medical, and Boston Scientific. Dr. Horton is on the Speakers' Bureau of Medtronic, St. Jude Medical, and Boston Scientific; is a consultant for Hansen Medical and Atritech; and is on the clinical advisory panel of Biosense-Webster. Dr. Burkhardt is a chief medical advisor for Stereotaxis. Dr. Haissaguerre has received presentation fees from BW/Bard. Dr. Raviele is on the Speakers' Bureau of Biosense-Webster, and is a consultant to and advisory board member of Sanofi-Aventis. Dr. Natale has received a research grant from St. Jude Medical and speaker honoraria from St. Jude Medical, Medtronic, Biosense-Webster, and Boston Scientific.
PY - 2010/2/23
Y1 - 2010/2/23
N2 - Objectives: The aim of this multicenter study was to evaluate the safety of discontinuing oral anticoagulation therapy (OAT) after apparently successful pulmonary vein isolation. Background: Atrial fibrillation (AF) is associated with an increased risk of thromboembolic events (TE) and often requires OAT. Pulmonary vein isolation is considered an effective treatment for AF. Methods: We studied 3,355 patients, of whom 2,692 (79% male, mean age 57 ± 11 years) discontinued OAT 3 to 6 months after ablation (Off-OAT group) and 663 (70% male, mean age 59 ± 11 years) remained on OAT after this period (On-OAT group). CHADS2 (congestive heart failure, hypertension, age [75 years and older], diabetes mellitus, and a history of stroke or transient ischemic attack) risk scores of 1 and ≥2 were recorded in 723 (27%) and 347 (13%) Off-OAT group patients and in 261 (39%) and 247 (37%) On-OAT group patients, respectively. Results: During follow-up (mean 28 ± 13 months vs. 24 ± 15 months), 2 (0.07%) Off-OAT group patients and 3 (0.45%) On-OAT group patients had an ischemic stroke (p = 0.06). No other thromboembolic events occurred. No Off-OAT group patient with a CHADS2 risk score of ≥2 had an ischemic stroke. A major hemorrhage was observed in 1 (0.04%) Off-OAT group patient and 13 (2%) On-OAT group patients (p < 0.0001). Conclusions: In this nonrandomized study, the risk-benefit ratio favored the suspension of OAT after successful AF ablation even in patients at moderate-high risk of TE. This conclusion needs to be confirmed by future large randomized trials.
AB - Objectives: The aim of this multicenter study was to evaluate the safety of discontinuing oral anticoagulation therapy (OAT) after apparently successful pulmonary vein isolation. Background: Atrial fibrillation (AF) is associated with an increased risk of thromboembolic events (TE) and often requires OAT. Pulmonary vein isolation is considered an effective treatment for AF. Methods: We studied 3,355 patients, of whom 2,692 (79% male, mean age 57 ± 11 years) discontinued OAT 3 to 6 months after ablation (Off-OAT group) and 663 (70% male, mean age 59 ± 11 years) remained on OAT after this period (On-OAT group). CHADS2 (congestive heart failure, hypertension, age [75 years and older], diabetes mellitus, and a history of stroke or transient ischemic attack) risk scores of 1 and ≥2 were recorded in 723 (27%) and 347 (13%) Off-OAT group patients and in 261 (39%) and 247 (37%) On-OAT group patients, respectively. Results: During follow-up (mean 28 ± 13 months vs. 24 ± 15 months), 2 (0.07%) Off-OAT group patients and 3 (0.45%) On-OAT group patients had an ischemic stroke (p = 0.06). No other thromboembolic events occurred. No Off-OAT group patient with a CHADS2 risk score of ≥2 had an ischemic stroke. A major hemorrhage was observed in 1 (0.04%) Off-OAT group patient and 13 (2%) On-OAT group patients (p < 0.0001). Conclusions: In this nonrandomized study, the risk-benefit ratio favored the suspension of OAT after successful AF ablation even in patients at moderate-high risk of TE. This conclusion needs to be confirmed by future large randomized trials.
KW - atrial fibrillation
KW - catheter ablation
KW - oral anticoagulation
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U2 - 10.1016/j.jacc.2009.11.039
DO - 10.1016/j.jacc.2009.11.039
M3 - Article
C2 - 20170810
AN - SCOPUS:76449121418
SN - 0735-1097
VL - 55
SP - 735
EP - 743
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 8
ER -