Anticoagulation after catheter ablation of atrial fibrillation: An unnecessary evil? A systematic review and

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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

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Riccardo Proietti1, Ahmed AlTurki2, Luigi Di Biase3,4

  • 1Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy.

Journal of Cardiovascular Electrophysiology
|December 22, 2018
PubMed

Insights

Discontinuing oral anticoagulation after atrial fibrillation ablation is safe, reducing bleeding risk without increasing cerebrovascular events. This meta-analysis suggests a favorable risk-benefit balance for stopping anticoagulation post-ablation.

Area of Science:

  • Cardiology
  • Clinical Research
  • Evidence Synthesis

Background:

  • Current atrial fibrillation (AF) management relies on CHA2DS2-VASc scores for cerebrovascular event (CVE) prediction.
  • Guidelines recommend continued oral anticoagulation (OAC) post-AF catheter ablation.
  • Uncertainty exists regarding persistent CVE risk after successful ablation.

Purpose of the Study:

  • To systematically review and meta-analyze studies comparing CVE and bleeding risk in AF patients on or off OAC after catheter ablation.
  • To evaluate the risk-benefit ratio of continuing OAC post-ablation based on risk scores.

Main Methods:

  • Systematic literature review of studies up to July 31, 2018.
  • Inclusion of studies reporting CVE post-AF ablation comparing on- vs. off-OAC patients.
  • Random-effects models used for meta-analysis, stratified by CHADS2 and CHA2DS2-VASc scores.

Main Results:

  • 16 studies with 25,177 patients (13,166 off-OAC, 12,011 on-OAC) were analyzed.
  • No significant difference in CVE incidence between on-OAC and off-OAC groups post-ablation (RR 0.66; 95% CI 0.38-1.15).
  • Off-OAC patients experienced significantly less bleeding (RR 0.17; 95% CI 0.09-0.34). AF recurrence impacted treatment effect (P=0.001).

Conclusions:

  • The risk-benefit ratio favors discontinuing OAC after successful AF ablation, even in moderate-high risk patients.
  • Further investigation is needed for non-vitamin K antagonist oral anticoagulants.
  • Suspension of OAT post-ablation appears safe and beneficial regarding bleeding risk.
Abstract

Keywords:
anticoagulationatrial fibrillationbleedingcatheter ablationmeta-analysisstroke

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