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Long-term events following atrial fibrillation rate control or transcatheter ablation: a multicenter observational

Cristina Gallo1, Alberto Battaglia, Matteo Anselmino

  • 1aDivision of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, TurinbDivision of Cardiology, Department of Internal Medicine, Cardinal Massaia Hospital, AsticDivision of Cardiology, Mauriziano Umberto I Hospital, Turin, Italy.

Journal of Cardiovascular Medicine (Hagerstown, Md.)
|August 4, 2015
PubMed

Insights

Discontinuing vitamin K antagonists (AVK) after atrial fibrillation transcatheter ablation (AFTCA) significantly reduces hemorrhagic events without increasing thromboembolic risk. Routine monitoring is crucial for patients with high risk following AFTCA.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Thrombosis Research

Background:

  • Atrial fibrillation (AF) elevates thromboembolic risk, necessitating oral anticoagulation.
  • Vitamin K antagonists (AVK) mitigate thromboembolic events but increase bleeding complications.

Purpose of the Study:

  • To compare long-term cerebral thromboembolic and hemorrhagic event rates.
  • To evaluate outcomes in AF patients managed with rhythm control via atrial fibrillation transcatheter ablation (AFTCA) versus rate control.
  • To assess the impact of AVK continuation or discontinuation post-AFTCA.

Main Methods:

  • Retrospective analysis of 1500 AF patients across three centers.
  • Patients were divided into three groups: AFTCA with AVK (Group A), AFTCA without AVK (Group B), and rate control with AVK (Group C).
  • Follow-up averaged 60±28 months, recording thromboembolic and hemorrhagic events.

Main Results:

  • No significant difference in thromboembolic events across groups (1-2.2%).
  • Hemorrhagic events were significantly lower in the AFTCA without AVK group (Group B) compared to Group A and C (0% vs. 1.8-2.4%).
  • All thromboembolic events post-AFTCA occurred in patients with AF relapses (4%), highlighting the importance of monitoring.

Conclusions:

  • Continuing AVK post-AFTCA, particularly in low-to-intermediate risk patients, poses a greater hemorrhagic risk than its protective benefit.
  • Discontinuing AVK after AFTCA is safe regarding thromboembolic events and reduces bleeding.
  • Close rhythm monitoring is essential post-AFTCA, especially for high-risk patients, to detect relapses and manage anticoagulation effectively.
Abstract

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