Abstract
Oral Anticoagulant Use After AF Ablation Introduction We sought to gain insight into stroke risk after atrial fibrillation (AF) ablation. Methods and Results We followed 1,990 patients for >1 year (49 ± 29 months) who underwent AF ablation. Prior to stopping oral anticoagulants (OAC), we performed 3-week transtelephonic ECG monitoring (TTM) and taught patients heart rate and pulse assessment. Documented AF or inability to do monitoring or assess pulse precluded stopping OAC in CHADS2 ≥1 patients. OAC was stopped in 546/840 (65%) with CHADS2 = 0; 384/796 (48%) with CHADS2 = 1 and 101/354 (40%) with CHADS2 ≥ 2. Sixteen strokes or TIAs occurred (0.2%/patient-year); 5 in CHADS2 = 0 patients (all off OAC); 5 in CHADS2 = 1 (1 off and 4 on OAC); and 6 in CHADS2 ≥2 (2 off and 4 on OAC). Twelve of 16 patients (75%) with stroke or TIA had documented AF. In patients "off " OAC, stroke rate/year stratified by the CHADS2 score was similar (CHADS 2 = 0: 0.28%; CHADS2 = 1: 0.07%; CHADS2 ≥2: 0.50%; P = NS). There was no difference in stroke risk "on" versus "off " OAC in CHADS2 = 1 (0.48% vs. 0.07%) or CHADS2 ≥2 (0.39% vs. 0.50%). Risk of major bleeding per patient year "on" OAC was > "off " OAC (13/1,138 (1.14%) versus 1/832 (0.1%); P<0.016). Conclusions Post-AF ablation with OAC guided by TTM and pulse assessment: (1) Overall stroke or TIA rate risk is low and risk is due to recurrent AF and (2) OAC can be stopped in 40% of CHADS2 ≥2 patients with low stroke and hemorrhagic risk.
Original language | English (US) |
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Pages (from-to) | 591-596 |
Number of pages | 6 |
Journal | Journal of cardiovascular electrophysiology |
Volume | 25 |
Issue number | 6 |
DOIs | |
State | Published - Jun 2014 |
Externally published | Yes |
Keywords
- CVA
- atrial fibrillation
- catheter ablation
- oral anticoagulation
- stroke
- thromboembolism
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)