title: Long-term events following atrial fibrillation rate control or transcatheter ablation: a multicenter observational study.
abstract: BACKGROUND
  Atrial fibrillation increases thromboembolic risk. Oral anticoagulation with antivitamin K (AVK) reduces thromboembolic event rate, but increases hemorrhagic risk.
  
  
  OBJECTIVE
  The aim of the present study was to describe long-term cerebral thromboembolic/hemorrhagic event rates in atrial fibrillation patients managed by rhythm control, pursued by atrial fibrillation transcatheter ablation (AFTCA), and rate control strategy.
  
  
  RESULTS
  One thousand and five hundred consecutive patients referring to three medical care centers for atrial fibrillation were retrospectively divided into three groups: AFTCA maintaining AVK (group A); AFTCA discontinuing AVK (group B); and rate control strategy and AVK (group C). Thromboembolic and hemorrhagic events were recorded in 60 ± 28 months of follow-up. Thromboembolic events did not differ between the groups (5/500, 1% group A; 7/500, 1.4% group B; 11/500, 2.2% group C; P = 0.45), and hemorrhagic events were greater in group A (9/500, 1.8%) and C (12/500, 2.4%) than in group B (no events; P = 0.003). Among patients with CHA2DS2 VASc score 2 or less, thromboembolic events did not differ in the group discontinuing AVK (group B, 4/388, 1%) or not (group A, 1/319, 0.3%; P = 0.38), whereas hemorrhagic events were more common in patients on AVK (5/319, 1.5% group A and 3/175, 1.7% group C; P = 0.02) compared with those discontinuing AVK (0/388, group B). Following AFTCA (groups A and B), 299/1000 experienced atrial fibrillation relapses; all thromboembolic events (12/299, 4%) occurred within these patients (P < 0.001).
  
  
  CONCLUSIONS
  Considering this multicenter design study, AVK continuation following AFTCA, especially within patients with low-to-intermediate thromboembolic risk, confers a hemorrhagic risk greater to the thromboembolic protective effect. All thromboembolic events following AFTCA occur within patients experiencing atrial fibrillation relapses; therefore, in patients with high thromboembolic risk routine rhythm monitoring is essential after AVK discontinuation.
authors.affiliation: aDivision of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, TurinbDivision of Cardiology, Department of Internal Medicine, Cardinal Massaia Hospital, AsticDivision of Cardiology, Mauriziano Umberto I Hospital, Turin, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Gallo
authors.forename: Alberto
authors.initials: A
authors.lastname: Battaglia
authors.forename: Matteo
authors.initials: M
authors.lastname: Anselmino
authors.forename: Francesca
authors.initials: F
authors.lastname: Bianchi
authors.forename: Stefano
authors.initials: S
authors.lastname: Grossi
authors.forename: Giulia
authors.initials: G
authors.lastname: Nangeroni
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Toso
authors.forename: Luca
authors.initials: L
authors.lastname: Gaido
authors.forename: Marco
authors.initials: M
authors.lastname: Scaglione
authors.forename: Federico
authors.initials: F
authors.lastname: Ferraris
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D017115:Catheter Ablation; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology*; D006339:Heart Rate; D006801:Humans; D007558:Italy / Q000453:epidemiology; D012189:Retrospective Studies