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01.06.2015 | Original Paper

Oral anticoagulation is frequently discontinued after ablation of paroxysmal atrial fibrillation despite previous stroke: data from the German Ablation Registry

verfasst von: Jana Mareike Nührich, Karl-Heinz Kuck, Dietrich Andresen, Daniel Steven, Stefan G. Spitzer, Ellen Hoffmann, Burghard Schumacher, Lars Eckardt, Johannes Brachmann, Thorsten Lewalter, Matthias Hochadel, Jochen Senges, Stephan Willems, Boris A. Hoffmann

Erschienen in: Clinical Research in Cardiology | Ausgabe 6/2015

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Abstract

Aims

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).

Conclusion

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.

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Titel: Oral anticoagulation is frequently discontinued after ablation of paroxysmal atrial fibrillation despite previous stroke: data from the German Ablation Registry
verfasst von: Jana Mareike Nührich
Karl-Heinz Kuck
Dietrich Andresen
Daniel Steven
Stefan G. Spitzer
Ellen Hoffmann
Burghard Schumacher
Lars Eckardt
Johannes Brachmann
Thorsten Lewalter
Matthias Hochadel
Jochen Senges
Stephan Willems
Boris A. Hoffmann
Publikationsdatum: 01.06.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Research in Cardiology / Ausgabe 6/2015
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-014-0804-1

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Oral anticoagulation is frequently discontinued after ablation of paroxysmal atrial fibrillation despite previous stroke: data from the German Ablation Registry

Abstract