Long-term oral anticoagulation for patients after successful catheter ablation of atrial fibrillation: is it necessary?
OBJECTIVE
Catheter ablation for atrial fibrillation is an effective rhythm-control therapy for selected patients. Currently, it is unknown whether maintenance of sinus rhythm after atrial fibrillation ablation can reduce one's stroke risk. If so, this may potentially obviate the need to treat patients with long-term oral anticoagulation (OAC). This article reviews the available evidence and areas of uncertainty pertaining to this question.


RESULTS
To date, no randomized trial data exist on this topic. Analyses from health administrative databases and observational registries suggested that atrial fibrillation patients who underwent catheter ablation had lower risk of stroke when compared with those who did not. Among patients who maintained sinus rhythm after ablation, low rates of stroke (<0.7% per year) were observed even after discontinuation of OAC therapy. These findings raise the possibility that successful catheter ablation may lower one's stroke risk to a point at which long-term OAC therapy is not obligatory.


CONCLUSIONS
Whether successful atrial fibrillation ablation reduces one's stroke risk is unknown. Low stroke risks were reported by observational studies in patients who maintained sinus rhythm after ablation despite OAC cessation. High-quality, randomized trial data are needed to provide clarity on this key unanswered question.
aPeterMunk Cardiac Center, University Health Network, Toronto, Canada bDepartment of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany cUniversity of Ottawa Heart Institute, Ottawa dSouthlake Regional Health Centre, Newmarket, Ontario, Canada.
Andrew C T
AC
Ha
Gerhard
G
Hindricks
David H
DH
Birnie
Atul
A
Verma
D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D020521:Stroke / Q000517:prevention & control*; D015996:Survival Rate; D013923:Thromboembolism / Q000517:prevention & control*; D016896:Treatment Outcome; D028761:Withholding Treatment
D000925:Anticoagulants