The Risk of Thromboembolism and Need for Oral Anticoagulation After Successful Atrial Fibrillation Ablation

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

Research output: Contribution to journalArticle

197 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)735-743
Number of pages9
JournalJournal of the American College of Cardiology
Volume55
Issue number8
DOIs
StatePublished - Feb 23 2010
Externally publishedYes

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Thromboembolism
Group Psychotherapy
Atrial Fibrillation
Pulmonary Veins
Stroke
Therapeutics
Transient Ischemic Attack
Multicenter Studies
Suspensions
Diabetes Mellitus
Heart Failure
Odds Ratio
Hemorrhage
Hypertension
Safety

Keywords

  • atrial fibrillation
  • catheter ablation
  • oral anticoagulation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Themistoclakis, S., Corrado, A., Marchlinski, F. E., Jais, P., Zado, E., Rossillo, A., ... Natale, A. (2010). The Risk of Thromboembolism and Need for Oral Anticoagulation After Successful Atrial Fibrillation Ablation. Journal of the American College of Cardiology, 55(8), 735-743. https://doi.org/10.1016/j.jacc.2009.11.039

The Risk of Thromboembolism and Need for Oral Anticoagulation After Successful Atrial Fibrillation Ablation. / Themistoclakis, Sakis; Corrado, Andrea; Marchlinski, Francis E.; Jais, Pierre; Zado, Erica; Rossillo, Antonio; Di Biase, Luigi; Schweikert, Robert A.; Saliba, Walid I.; Horton, Rodney; Mohanty, Prasant; Patel, Dimpi; Burkhardt, David J.; Wazni, Oussama M.; Bonso, Aldo; Callans, David J.; Haissaguerre, Michel; Raviele, Antonio; Natale, Andrea.

In: Journal of the American College of Cardiology, Vol. 55, No. 8, 23.02.2010, p. 735-743.

Research output: Contribution to journalArticle

Themistoclakis, S, Corrado, A, Marchlinski, FE, Jais, P, Zado, E, Rossillo, A, Di Biase, L, Schweikert, RA, Saliba, WI, Horton, R, Mohanty, P, Patel, D, Burkhardt, DJ, Wazni, OM, Bonso, A, Callans, DJ, Haissaguerre, M, Raviele, A & Natale, A 2010, 'The Risk of Thromboembolism and Need for Oral Anticoagulation After Successful Atrial Fibrillation Ablation', Journal of the American College of Cardiology, vol. 55, no. 8, pp. 735-743. https://doi.org/10.1016/j.jacc.2009.11.039
Themistoclakis, Sakis ; Corrado, Andrea ; Marchlinski, Francis E. ; Jais, Pierre ; Zado, Erica ; Rossillo, Antonio ; Di Biase, Luigi ; Schweikert, Robert A. ; Saliba, Walid I. ; Horton, Rodney ; Mohanty, Prasant ; Patel, Dimpi ; Burkhardt, David J. ; Wazni, Oussama M. ; Bonso, Aldo ; Callans, David J. ; Haissaguerre, Michel ; Raviele, Antonio ; Natale, Andrea. / The Risk of Thromboembolism and Need for Oral Anticoagulation After Successful Atrial Fibrillation Ablation. In: Journal of the American College of Cardiology. 2010 ; Vol. 55, No. 8. pp. 735-743.
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abstract = "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.",
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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

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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