title: Oral anticoagulation is frequently discontinued after ablation of paroxysmal atrial fibrillation despite previous stroke: data from the German Ablation Registry.
abstract: OBJECTIVE
  Atrial fibrillation (AF) is the most common cause of ischemic stroke. Recent data suggest that AF patients after successful ablation have the same risk for thromboembolic events (TE) as patients without AF. Despite current guideline recommendations it is still under debate if oral anticoagulation (OAC) can be safely discontinued after ablation. We analyzed follow-up (FU) after ablation of paroxysmal AF (PAF) in a high- (previous stroke; group 1) and a low-risk group (no previous stroke; group 2) based on data from the German Ablation Registry to reveal real-life prescription behavior.
  
  
  METHODS
  Overall 29 centers in Germany participated by performing AF-ablation. Between April 2008 and April 2011, 83 patients in group 1 and 377 patients in group 2 with a first ablation of PAF were included in the registry.
  
  
  RESULTS
  Mean CHA2DS2-VASc-Score was 4.2 ± 1.4 (group 1) vs. 1.6 ± 1.2 (group 2) (p < 0.0001). No peri-interventional TE was observed. Arrhythmia recurrence was seen in 47.4 vs. 48.4% (p = 0.79) during a median FU of 489 (453-782) days, resulting in a repeat procedure in 20.0 vs. 20.7% (p = 0.88), respectively. OAC was discontinued in 38.6% in group 1 vs. 66.3% in group 2 (p < 0.0001) during FU. TE during FU occurred more often in group 1 than in group 2 (4.3 vs. 0.3%, p < 0.05).
  
  
  CONCLUSIONS
  Even in patients with previous stroke, OAC was frequently discontinued during FU after PAF ablation in this observational study. However, TE occurred significantly more frequent in these high-risk patients. These data argue against OAC discontinuation after ablation in patients with previous stroke.
authors.affiliation: Department of Cardiology and Electrophysiology, University Heart Center, Martinistraße 52, 20246, Hamburg, Germany, j.nuehrich@uke.de.
authors.forename: Jana Mareike
authors.initials: JM
authors.lastname: Nührich
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.forename: Dietrich
authors.initials: D
authors.lastname: Andresen
authors.forename: Daniel
authors.initials: D
authors.lastname: Steven
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Spitzer
authors.forename: Ellen
authors.initials: E
authors.lastname: Hoffmann
authors.forename: Burghard
authors.initials: B
authors.lastname: Schumacher
authors.forename: Lars
authors.initials: L
authors.lastname: Eckardt
authors.forename: Johannes
authors.initials: J
authors.lastname: Brachmann
authors.forename: Thorsten
authors.initials: T
authors.lastname: Lewalter
authors.forename: Matthias
authors.initials: M
authors.lastname: Hochadel
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.forename: Stephan
authors.initials: S
authors.lastname: Willems
authors.forename: Boris 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 / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012042:Registries; D012306:Risk; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control
chemical_list: D000925:Anticoagulants