title: Patterns of Anticoagulation Use and Cardioembolic Risk After Catheter Ablation for Atrial Fibrillation.
abstract: BACKGROUND
  There is significant practice variation in oral anticoagulation (OAC) use following catheter ablation for atrial fibrillation. It is not clear whether the risk of cardioembolism increases after discontinuation of OAC following catheter ablation.
  
  
  RESULTS
  We identified 6886 patients within a large national administrative claims database who underwent catheter ablation for atrial fibrillation between January 1, 2005, and September 30, 2014. We assessed the effect of time off of OAC by CHA2DS2-VASc score (after adjusting for other comorbidities) on risk of cardioembolism, using Cox proportional hazards models. There was an increase in the use of non-vitamin K OAC after ablation from 0% in 2005 to 69.8% in 2014. OAC discontinuation was high, with only 60.5% and 31.3% of patients remaining on OAC at 3 and 12 months, respectively. The rate of discontinuation was higher in low-risk patients (82% versus 62.5% at 12 months for CHA2DS2-VASc 0-1 versus ≥2, respectively; P<0.001). Stroke occurred in 1.4% of patients with CHA2DS2-VASc ≥2 and 0.3% of those with CHA2DS2-VASc 0 or 1 over the study follow-up. The risk of cardioembolism in the first 3 months after ablation was increased among those with any time off OAC (hazard ratio 8.06 [95% CI 1.53-42.3], P<0.05). The risk of cardioembolism beyond 3 months was increased with OAC discontinuation among high-risk patients (hazard ratio 2.48 [95% CI 1.11-5.52], P<0.05) but not low-risk patients.
  
  
  CONCLUSIONS
  The overall risk of stroke in postablation patients is low; however, OAC discontinuation after ablation is common and is associated with increased risk of cardioembolism for all patients within the first 3 months and for high-risk patients in the long term. Continuing OAC for at least 3 months in all patients and indefinitely in high-risk patients appears to be the safest strategy.
authors.affiliation: Heart Rhythm Section, Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.A.N., A.J.D., K.C.S., S.J.A., P.A.F., D.L.P., B.J.G.) Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN (P.A.N., X.Y., H.V.H., L.R.S., N.D.S.).
authors.forename: Peter A
authors.initials: PA
authors.lastname: Noseworthy
authors.affiliation: Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN (P.A.N., X.Y., H.V.H., L.R.S., N.D.S.).
authors.forename: Xiaoxi
authors.initials: X
authors.lastname: Yao
authors.affiliation: Heart Rhythm Section, Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.A.N., A.J.D., K.C.S., S.J.A., P.A.F., D.L.P., B.J.G.).
authors.forename: Abhishek J
authors.initials: AJ
authors.lastname: Deshmukh
authors.affiliation: Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN (P.A.N., X.Y., H.V.H., L.R.S., N.D.S.).
authors.forename: Holly
authors.initials: H
authors.lastname: Van Houten
authors.affiliation: Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN (P.A.N., X.Y., H.V.H., L.R.S., N.D.S.).
authors.forename: Lindsey R
authors.initials: LR
authors.lastname: Sangaralingham
authors.affiliation: Heart Rhythm Section, Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.A.N., A.J.D., K.C.S., S.J.A., P.A.F., D.L.P., B.J.G.).
authors.forename: Konstantinos C
authors.initials: KC
authors.lastname: Siontis
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, NC (J.P.P., B.J.G.).
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
authors.affiliation: Heart Rhythm Section, Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.A.N., A.J.D., K.C.S., S.J.A., P.A.F., D.L.P., B.J.G.).
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Asirvatham
authors.affiliation: Heart Rhythm Section, Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.A.N., A.J.D., K.C.S., S.J.A., P.A.F., D.L.P., B.J.G.).
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.affiliation: Heart Rhythm Section, Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.A.N., A.J.D., K.C.S., S.J.A., P.A.F., D.L.P., B.J.G.).
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Packer
authors.affiliation: Heart Rhythm Section, Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.A.N., A.J.D., K.C.S., S.J.A., P.A.F., D.L.P., B.J.G.) Division of Cardiology, Duke University Medical Center, Durham, NC (J.P.P., B.J.G.).
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.affiliation: Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN (P.A.N., X.Y., H.V.H., L.R.S., N.D.S.) Optum Labs, Cambridge, MA (N.D.S.).
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000639:trends; D016208:Databases, Factual; D004334:Drug Administration Schedule; D004617:Embolism / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians' / Q000639:trends; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D000925:Anticoagulants
keywords: ablation; anticoagulation; atrial fibrillation; stroke; transient ischemic attack