Winkle Roger A, Mead R Hardwin, Engel Gregory, Kong Melissa H, Patrawala Rob A
Silicon Valley Cardiology, 1950 University Avenue, Suite 160, East Palo Alto, CA, 94303, USA,
J Interv Card Electrophysiol. 2013 Dec;38(3):147-53. doi: 10.1007/s10840-013-9835-1. Epub 2013 Oct 8.
This study was conducted to examine the outcomes in patients with prior stroke/transient ischemic attack (CVA/TIA) after atrial fibrillation (AF) ablation and the feasibility of discontinuing oral anticoagulation (OAC).
This study examined long-term outcomes following AF ablations in 108 patients with a history of prior thromboembolic CVA/TIA. Because of risks of OAC, we frequently discontinue OAC in these patients after successful ablation. These patients understand the risks/benefits of discontinuing OAC and remain on OAC for a longer time following successful AF ablation, compared to our patients without prior CVA/TIA.
Patient age was 66.2 ± 9.0 years with an average CHADS2 score = 3.0 ± 0.9 and CHA2DS2-VASc score = 4.1 ± 1.4. Following 1.24 ablations, 71 (65.7%) patients were AF free 2.8 ± 1.6 (median 2.3) years after their last ablation. OAC was discontinued in 55/71 (77.5%) patients an average of 7.3 months following the final ablation. These 55 patients had 2.2 ± 1.3 (median 1.8) years of follow-up off of OAC. Kaplan-Meier analysis suggests little AF recurrence >1 year following initial or final ablations, suggesting that 1 year post successful ablation may be the appropriate time to consider discontinuing OAC. Thirty-seven patients had AF postablation, and 32/37 (86.5%) remained on OAC. One patient with a mechanical valve had a stroke despite OAC. Bleeding occurred in 8.3% of patients on OAC and 0% of patients off OAC (P = 0.027).
Patients with prior CVA/TIAs, who undergo successful AF ablation, have a low incidence of subsequent thromboembolic events. Most patients who appear AF free postablation may be able to discontinue OAC after successful ablation with a low thromboembolic risk and with a reduced bleeding risk.
本研究旨在探讨既往有卒中/短暂性脑缺血发作（CVA/TIA）的患者在房颤（AF）消融术后的结局以及停用口服抗凝药（OAC）的可行性。
本研究对108例有血栓栓塞性CVA/TIA病史的患者进行AF消融术后的长期结局研究。由于OAC存在风险，我们在这些患者成功消融后经常停用OAC。与我们没有既往CVA/TIA的患者相比，这些患者了解停用OAC的风险/益处，并在成功进行AF消融后更长时间内继续使用OAC。
患者年龄为66.2±9.0岁，平均CHADS2评分为3.0±0.9，CHA2DS2-VASc评分为4.1±1.4。在进行1.24次消融后，71例（65.7%）患者在最后一次消融后2.8±1.6（中位数2.3）年无房颤。55/71（77.5%）例患者在最后一次消融后平均7.3个月停用OAC。这55例患者在停用OAC后有2.2±1.3（中位数1.8）年的随访。Kaplan-Meier分析表明，在初次或最后一次消融后1年以上房颤复发率较低，这表明成功消融后1年可能是考虑停用OAC的合适时间。37例患者消融后发生房颤，32/37（86.5%）例患者继续使用OAC。1例有机械瓣膜的患者尽管使用了OAC仍发生了卒中。使用OAC的患者中有8.3%发生出血，停用OAC的患者中出血发生率为0%（P=0.027）。
既往有CVA/TIA且AF消融成功的患者，随后血栓栓塞事件的发生率较低。大多数消融后无房颤的患者在成功消融后可能能够停用OAC，血栓栓塞风险低且出血风险降低。
