title: Role of anticoagulation therapy after pulmonary vein antrum isolation for atrial fibrillation treatment.
abstract: BACKGROUND
  Atrial fibrillation (AF) increases the risk of atrioembolic stroke. However, the role of anticoagulation therapy (OAT) in preventing cerebrovascular accidents (CVA) after intracardiac echocardiography-guided pulmonary vein antrum isolation (ICE-PVAI) is still unclear. In the present study, we evaluated the incidence of CVA following the interruption of OAT 3 months after ICE-PVAI.
  
  
  METHODS
  Between September 2002 and March 2004, 85 consecutive patients (72 men, mean age 62 +/- 7 years) underwent ICE-PVAI for symptomatic drug-refractory AF. Heart disease was present in 61 patients (72%) (left ventricular ejection fraction = 58 +/- 6%, LA diameter 44 +/- 6 mm). Eighty-five consecutive patients who underwent electrical cardioversion (EC) for AF, matched for age, sex and heart disease, served as a control group. After 3 months, OAT was stopped unless one of the following conditions was observed: (i) AF-recurrence; (ii) severe pulmonary vein stenosis; (iii) non-good atrial contractility on transesophageal echocardiography; or (iv) other indications for OAT.
  
  
  RESULTS
  In the study group, OAT was stopped after 3 months in 77 patients (90%) and no CVA occurred during the remaining follow-up (15 +/- 7 months). In the control group, 1 month after EC, OAT was stopped by the referring physician in 29 patients (34%). A stroke occurred in five patients (6%) (P = 0.09; mean P = 0.059) during follow-up. In two of these (2%), the stroke was fatal.
  
  
  CONCLUSIONS
  Stopping OAT 3 months after ICE-PVAI seems to be safe in patients without AF recurrences after the first 3 months following ablation. Further randomized-controlled studies are needed to confirm these preliminary data.
authors.affiliation: Department of Cardiology, Umberto I Hospital, Mestre-Venice, Italy. a.rossillo@tiscali.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Rossillo
authors.forename: Aldo
authors.initials: A
authors.lastname: Bonso
authors.forename: Sakis
authors.initials: S
authors.lastname: Themistoclakis
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Riccio
authors.forename: Michela
authors.initials: M
authors.lastname: Madalosso
authors.forename: Andrea
authors.initials: A
authors.lastname: Corrado
authors.forename: Bruno
authors.initials: B
authors.lastname: De Piccoli
authors.forename: Antonio
authors.initials: A
authors.lastname: Raviele
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D006493:Heparin