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Clinical Research in Cardiology

, Volume 104, Issue 6, pp 463–470 | Cite as

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

  • Jana Mareike NührichEmail author
  • 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
Original Paper

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.

Keywords

Atrial fibrillation Pulmonary vein isolation Thromboembolic complications Anticoagulation Stroke 

Abbreviations

AF

Atrial fibrillation

ASA

Acetylsalicylic acid

CFAE

Complex fractionated atrial electrogram

FU

Follow-up

LVEF

Left ventricular ejection fraction

MACCE

Major adverse cardiac and cerebrovascular events: death, myocardial infarction, stroke

Min

Minutes

OAC

Oral anticoagulation

PAF

Paroxysmal atrial fibrillation

PVI

Pulmonary vein isolation

RF

Radiofrequency

SAE

Severe non-fatal adverse events: myocardial infarction, stroke, major bleeding

TE

Thromboembolic events

TIA

Transient ischemic attack

Notes

Acknowledgments

This project was supported by an unrestricted grant from the Institute for Research in Myocardial Infarction (Ludwigshafen, Germany).

Conflict of interest

All authors declare no conflicts of interest regarding this manuscript.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Jana Mareike Nührich
    • 1
    Email author
  • Karl-Heinz Kuck
    • 2
  • Dietrich Andresen
    • 3
  • Daniel Steven
    • 1
  • Stefan G. Spitzer
    • 4
  • Ellen Hoffmann
    • 5
  • Burghard Schumacher
    • 6
  • Lars Eckardt
    • 7
  • Johannes Brachmann
    • 8
  • Thorsten Lewalter
    • 9
  • Matthias Hochadel
    • 10
  • Jochen Senges
    • 10
  • Stephan Willems
    • 1
  • Boris A. Hoffmann
    • 1
  1. 1.Department of Cardiology and ElectrophysiologyUniversity Heart CenterHamburgGermany
  2. 2.Department of CardiologyAsklepios Hospital St. GeorgHamburgGermany
  3. 3.Department of CardiologyVivantes HospitalBerlinGermany
  4. 4.Praxisklinik Herz und GefäßeDresdenGermany
  5. 5.Department of CardiologyMunicipal Hospital BogenhausenMunichGermany
  6. 6.Westpfalz-KlinikumKaiserslauternGermany
  7. 7.Division of ElectrophysiologyDepartment of Cardiovascular MedicineMuensterGermany
  8. 8.Department of CardiologyHospital CoburgCoburgGermany
  9. 9.Isar Heart Centre MunichMunichGermany
  10. 10.Institute for Research in Myocardial InfarctionLudwigshafenGermany

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