Discontinuing Oral Anticoagulation after Atrial Fibrillation Ablation: Time for a Paradigm Shift?

AF is the most common arrhythmia in adult patients and frequently requires oral anticoagulation (OAC) for stroke prevention. Catheter ablation for AF has become an increasingly popular rhythm control strategy, although there is no clear consensus on the safety of OAC discontinuation after ablation. While current guidelines recommend continuing OAC after AF ablation based on CHA₂DS₂-VASc score, recent evidence suggests it may be safe and beneficial to discontinue OAC in appropriate populations. Catheter ablation has been shown to reduce both overall AF burden and stroke risk in large prospective studies. The ALONE-AF and OCEAN trials demonstrated that discontinuing OAC after AF ablation did not increase stroke incidence, but did reduce clinically significant bleeding events. A possible framework for discontinuing OAC could involve a risk-stratified approach to guide ambulatory monitoring for AF recurrence. In summary, OAC discontinuation may be considered in patients with no or minimal evidence of AF recurrence after catheter ablation.