title: [Anticoagulation in high thromboembolic risk after catheter ablation for atrial fibrillation: results from the German Ablation Registry].
abstract: BACKGROUND
  Catheter ablation (CA) for atrial fibrillation (AF) is an effective therapeutic option for the treatment of symptomatic drug-refractory AF. According to current guidelines, the prevention of stroke and embolism is the most important therapeutic goal in AF and the recommendations for anticoagulation (OAC) after successful CA are based upon the CHA2DS2-VASc-Score 3. The aim of this study was to evaluate the use of OAC in patients with a high risk for thromboembolic events 1 year after CA and to identify predictor variables for discontinuation of OAC.
  
  
  METHODS
  Between January 2007 and January 2010 13092 patients were enrolled in the study. A total of 52 German electrophysiological centers agreed to participate in this prospective multicenter registry. 41 centers included patients undergoing CA for AF. Analysis included patients who were discharged with OAC after CA and had a CHA2DS2-VASc-Score ≥ 2. A centralized 1 year follow-up (FU) was conducted via telephone.
  
  
  RESULTS
  1300 patients fulfilled the inclusion criteria. One year after CA 51.8 % of these patients were on OAC. Factors significantly associated with discontinuation of OAC included no AF recurrence in FU (adjusted odds ratio (OR): 2.14, [95 % confidence interval (CI): 1.73-2.66], P < 0.001) and paroxysmal AF (OR: 1.53 [95 % CI: 1.29-1.81], P < 0.001). Factors associated with continuation of OAK were patient age (OR per 10 years: 0.79 [95 % CI: 0.68-0.91], P = 0.002), valvular heart disease (OR: 0.67 [95 % CI: 0.48-0.92], P = 0.013), an implanted pacemaker, defibrillator or a cardiac resynchronization therapy system (OR: 0.55 [95 % CI: 0.41-0.74], P < 0.001) and neurological events in hospital or during FU (OR: 0.40 [95 % CI: 0.18-0.88], P < 0.022).
  
  
  CONCLUSIONS
  Almost half of the patients with an indication for OAC are not adequately anticoagulated one year after CA for AF. Paroxysmal AF or freedom from AF is significantly associated with discontinuation of OAC.
authors.affiliation: Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf.
authors.forename: J
authors.initials: J
authors.lastname: Moser
authors.affiliation: Abteilung für Kardiologie, Asklepios Klinik St. Georg, Hamburg.
authors.forename: K H
authors.initials: KH
authors.lastname: Kuck
authors.affiliation: Klinik für Innere Medizin - Kardiologie, Vivantes Klinikum Am Urban, Berlin.
authors.forename: D
authors.initials: D
authors.lastname: Andresen
authors.affiliation: Praxisklinik Herz und Gefäße, Dresden.
authors.forename: S G
authors.initials: SG
authors.lastname: Spitzer
authors.affiliation: Klinik für Kardiologie und Intensivmedizin , Städtische Kliniken München, Klinikum Bogenhausen, München.
authors.forename: E
authors.initials: E
authors.lastname: Hoffmann
authors.affiliation: Medizinische Klinik II, Westpfalz-Klinikum, Kaiserslautern.
authors.forename: B
authors.initials: B
authors.lastname: Schumacher
authors.affiliation: Abteilung Rhythmologie, Department für Kardiologie und Angiologie, Universitätsklinikum Münster, Münster.
authors.forename: L
authors.initials: L
authors.lastname: Eckardt
authors.affiliation: II. Medizinische Klinik, Regiomed Klinik, Coburg.
authors.forename: J
authors.initials: J
authors.lastname: Brachmann
authors.affiliation: Klinik für Kardiologie und internistische Intensivmedizin, Isar Herz Zentrum, Isar Kliniken GmbH, München.
authors.forename: T
authors.initials: T
authors.lastname: Lewalter
authors.affiliation: Institut für Herzinfarktforschung, Ludwigshafen.
authors.forename: M
authors.initials: M
authors.lastname: Hochadel
authors.affiliation: Institut für Herzinfarktforschung, Ludwigshafen.
authors.forename: J
authors.initials: J
authors.lastname: Senges
authors.affiliation: Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf.
authors.forename: S
authors.initials: S
authors.lastname: Willems
authors.affiliation: Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf.
authors.forename: B A
authors.initials: BA
authors.lastname: Hoffmann
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D019983:Guideline Adherence; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012042:Registries; D018570:Risk Assessment; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants