Post-AF ablation anticoagulation: Real-world practice and predictors of therapy

Oral anticoagulation (OAC) is recommended for ≥3 months after catheter ablation (CA) for atrial fibrillation (AF) and indefinitely in patients at higher risk. Current practice and associated predictors are unknown.

To report current OAC practice among patients after AF ablation and identify features predictive of OAC therapy after ablation.

Patients with AF who underwent CA from January 1, 2017 to October 1, 2023 were identified from Optum's Clinformatics® Data Mart and stratified by CHA₂DS₂-VASc score into 4 groups. OAC treatment was assessed 30 and 365 days after CA. Automated machine learning was used to predict OAC use within 1 year after CA on the basis of demographic and clinical information; area under the receiver operating curve was reported.

We included 65,020 patients (mean age of 69; 39% female) with mean CHA₂DS₂-VASc score of 4.16 ± 2.03. OAC continuation fell steadily over the year after CA, especially among lower risk patients. In approximately 10%-20% of patients, OAC was not prescribed at the time of ablation or after across all risk groups. The area under the receiver operating curve for the total AF population was 0.607 (95% confidence interval, 0.587-0.614). Main predictors for OAC discontinuation at 1 year were lower CHA₂DS₂-VASc baseline score (w, 0.033), left atrial appendage occlusion after CA (w, 0.018), and bleeding event in the follow-up period (w, 0.010).

Discordant with guidelines recommendations, OAC discontinuation was common among patients with AF and at least moderate stroke risk. Stroke risk, left atrial appendage occlusion, and bleeding experience were the strongest determinants of OAC discontinuation but did not explain much of the discontinuation.