Efficacy of Oral Anticoagulation in Stroke Prevention among Sinus-Rhythm Patients Who Lack Left Atrial Mechanical Contraction after Cryoablation.
The customary recommendation is that oral anticoagulation be withdrawn a few months after cryoablation for atrial fibrillation, independently of left atrial mechanical contraction in patients in sinus rhythm. Recently, a 5-fold increase in stroke has been described in sinus-rhythm patients who lack atrial mechanical contraction. One aim of this study was to evaluate the efficacy of oral anticoagulation in preventing postoperative stroke in such patients. This prospective study divided 154 sinus-rhythm patients into 2 groups, depending on the presence (108 patients) or absence (46 patients) of left atrial mechanical contraction at 6 months after surgery, and monitored them annually for 5 years. Those without left atrial contraction were maintained on acenocumarol. The primary endpoint was the occurrence of ischemic stroke. The median follow-up period was 29 ± 16 months; 4 patients (2.5%), all belonging to the group with preserved atrial contraction, had ischemic stroke; the group of patients without left atrial contraction had no episodes of stroke during follow-up. Logistic binary regression analyses showed no evidence of factors independently predictive of stroke. Among anticoagulated patients in sinus rhythm without left atrial contraction, we found the incidence of stroke to be zero. In a small, nonrandomized group such as this, we cannot discount the element of chance, yet we suggest that maintaining anticoagulation might lower the incidence of stroke in this population.
José
J
Martínez-Comendador
Javier
J
Gualis
José Miguel
JM
Marcos-Vidal
Jonnatan
J
Buber
Carlos Esteban
CE
Martín
Jesús
J
Gomez-Plana
Miguel Angel
MA
Rodríguez
Ignacio
I
Iglesias-Garriz
David
D
Alonso
Carlos
C
Soria
Eva Higuera
EH
Miguélez
Mario
M
Castaño
D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D016279:Atrial Function, Left; D002545:Brain Ischemia / Q000453:epidemiology / Q000517:prevention & control*; D003452:Cryosurgery / Q000009:adverse effects*; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
D000925:Anticoagulants
Ablation; anticoagulants/therapeutic use; atrial appendage/surgery; atrial fibrillation/surgery; atrial function, left; catheter ablation; cryosurgery/methods; heart atria/surgery; myocardial contraction; prospective studies; sinus rhythm; stroke/prevention & control; thromboembolism; treatment outcome