title: Risk of stroke or transient ischemic attack after atrial fibrillation ablation with oral anticoagulant use guided by ECG monitoring and pulse assessment.
abstract: BACKGROUND
  We sought to gain insight into stroke risk after atrial fibrillation (AF) ablation.
  
  
  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 (CHADS2  = 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.
authors.affiliation: Hospital of the University of Pennsylvania, Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Riley
authors.forename: Erica
authors.initials: E
authors.lastname: Zado
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Hutchinson
authors.forename: David
authors.initials: D
authors.lastname: Lin
authors.forename: Rupa
authors.initials: R
authors.lastname: Bala
authors.forename: Fermin C
authors.initials: FC
authors.lastname: Garcia
authors.forename: David J
authors.initials: DJ
authors.lastname: Callans
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Cooper
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Verdino
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dixit
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D011674:Pulse / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D055815:Young Adult
chemical_list: D000925:Anticoagulants
keywords: CVA; atrial fibrillation; catheter ablation; oral anticoagulation; stroke; thromboembolism