Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
J Cardiovasc Electrophysiol. 2018 Jun;29(6):823-832. doi: 10.1111/jce.13476. Epub 2018 Mar 30.
Whether successful catheter ablation for atrial fibrillation (AF) reduces risk of cerebrovascular events (CVEs) remains controversial and whether oral anticoagulation therapy (OAT) can be safely discontinued in patients rendered free of AF recurrences remains unknown. We evaluated OAT use patterns and examined long-term rates of CVEs (stroke/TIA) and major bleeding episodes (MBEs) in patients with nonparoxysmal AF treated with catheter ablation.
Four hundred patients with nonparoxysmal AF (200 persistent, 200 longstanding persistent; mean age 60.3 ± 9.7 years, 82% male) undergoing first AF ablation were followed for 3.6 ± 2.4 years. OAT discontinuation during follow-up was permitted in selected patients per physician discretion. At last follow-up, allowing for multiple ablations, 172 (43.0%) patients were free of AF recurrence. Two hundred and seven (51.8%) discontinued OAT at some point; 174 (43.5%) were off OAT at last follow-up. Patients without AF recurrence were more likely to remain off OAT (HR 0.23 [95% CI 0.17-0.33]). Patients with persistent (versus longstanding persistent) AF type prior to ablation (HR 0.6 [CI 0.44-0.83]) and those with CHA DS -VASc score <2 (HR 0.56 [0.39-0.80]) were less likely to continue OAT. Seven patients had CVEs (incidence: 0.49/100 patient years) and 14 experienced MBE during follow-up (incidence: 0.98/100 patient years). Older age (P = 0.001) and coronary artery disease (P = 0.028) were associated with CVE.
Anticoagulation discontinuation in well selected, closely monitored patients following successful ablation of nonparoxysmal AF was associated with a low rate of clinical embolic CVEs. Prospective studies are required to confirm safety of OAT discontinuation after successful AF ablation.
房颤（AF）导管消融成功后是否降低脑血管事件（CVE）风险仍存在争议，以及在无 AF 复发的患者中是否可以安全停用口服抗凝治疗（OAT）仍未知。我们评估了非阵发性 AF 患者导管消融后的 OAT 使用模式，并研究了长期 CVE（中风/TIA）和主要出血事件（MBE）的发生率。
400 例非阵发性 AF 患者（200 例持续性，200 例长期持续性；平均年龄 60.3±9.7 岁，82%为男性）接受首次 AF 消融治疗后随访 3.6±2.4 年。根据医生的判断，允许在随访期间选择患者停用 OAT。最后一次随访时，考虑到多次消融，172 例（43.0%）患者无 AF 复发。207 例（51.8%）患者在某一时刻停止使用 OAT；174 例（43.5%）在最后一次随访时未使用 OAT。无 AF 复发的患者更有可能停用 OAT（HR 0.23 [95%CI 0.17-0.33]）。与消融前持续性 AF 类型（HR 0.6 [CI 0.44-0.83]）和 CHA DS -VASc 评分<2（HR 0.56 [0.39-0.80]）的患者相比，继续使用 OAT 的可能性更低。7 例患者发生 CVE（发生率：0.49/100 患者年），14 例患者在随访期间发生 MBE（发生率：0.98/100 患者年）。年龄较大（P=0.001）和冠心病（P=0.028）与 CVE 相关。
在成功消融非阵发性 AF 后，对精心选择且密切监测的患者停用抗凝治疗与临床栓塞性 CVE 发生率较低相关。需要前瞻性研究来确认成功消融 AF 后停用 OAT 的安全性。
