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Arrhythmia Recurrence After Atrial Fibrillation Ablation: Impact of Warfarin vs. Non-Vitamin K Antagonist Oral Anticoagulants

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Abstract

Purpose

Both warfarin and non-vitamin K antagonist oral anticoagulants (NOACs) have pleiotropic effects including anti-inflammatory and anti-fibrotic properties. This study aims to explore whether arrhythmia recurrence after AF ablation is influenced by the choice of oral anticoagulant.

Methods

We retrospectively studied all patients who underwent primary AF ablation between 2011 and 2017 and divided them into two groups according to the anticoagulant used: Warfarin vs. NOACs. The primary endpoint was atrial tachyarrhythmia recurrence after ablation.

Results

Of the 1106 patients who underwent AF ablation in the study period (median age 62.5 years; 71.5% males, 48.2% persistent AF), 697 (63%) received warfarin and 409 (37%) received NOACs. After a median of 26.4 months follow-up, arrhythmia recurrence was noted in 368 patients in warfarin group and 173 patients in NOACs group, with a 1-year recurrence probability of 35% vs. 36% (log rank P = 0.81) and 5-year recurrence probability of 62% vs. 63% (Log rank P = 0.32). However, NOACs use was associated with a higher probability of recurrence (46% for 1 year, 68% for 5 years) in patients with persistent AF compared with those taking warfarin (34% for 1 year, 63% for 5 years; log rank P = 0.01 and P = 0.02 respectively). Multivariate analysis indicated that in patients with persistent AF, use of NOACs was an independent risk factor of atrial tachyarrhythmia recurrence after ablation (HR 1.39, 95% CI 1.07–1.81, P = 0.013).

Conclusion

In this large contemporary cohort, overall AF recurrence after ablation was similar with NOACs or warfarin use. However, in patients with persistent AF, NOACs use was associated with a higher probability of arrhythmia recurrence and was an independent risk factor of recurrence at long-term follow-up.

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Data Availability

Data will be available upon reasonable request.

Abbreviations

AF:

Atrial fibrillation

AAD:

Antiarrhythmic drug

CI:

Confidence interval

HR:

Hazard ratio

LA:

Left atrium

NOACs:

Non-vitamin K antagonist oral anticoagulants

OAC:

Oral anticoagulant

PAR:

Protease-activated receptor

TEE:

Transesophageal echocardiography

VKA:

Vitamin K antagonist

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Funding

This work was partially supported by the National Natural Science Foundation of China (NSFC 81870243).

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Songnan Wen, Cristina Pislaru, Kristi H. Monahan, Stephanie M. Barnes, Douglas L. Packer, Sorin V. Pislaru & Samuel J. Asirvatham

  2. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China

    Songnan Wen

  3. Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA

    David O. Hodge

  4. Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA

    Samuel J. Asirvatham

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  1. Songnan Wen
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Contributions

KM, SB, and SNW were responsible for data acquisition. SNW was responsible for data interpretation and writing up of the paper. DH contributed to data acquisition and analysis. KM and CP helped with manuscript composition and proofreading. DP, SP, and SA contributed substantially to the conception and design of the study and helped with data interpretation, they also took overall responsibility for the study and final revision of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Samuel J. Asirvatham.

Ethics declarations

Ethics Approval and Consent to Participate

This study was approved by the Mayo Clinic Institutional Review Board. All patients signed informed consent to use their medical data for research purpose.

Research Involving Human Participants and/or Animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Consent for Publication

All authors read and approved the final manuscript.

Competing Interests

Dr. Packer reported receiving grants from the Abbott, Biosense Webster, Boston Scientific/EPT, CardioInsight, CardioFocus, Endosense, Hansen Medical, Medtronic, NIH, Robertson Foundation, St. Jude Medical, Siemens, and Thermedical; serving on the advisory board without compensation for Abbott, Biosense Webster, Inc., Boston Scientific, CardioFocus, Johnson & Johnson, Medtronic, St. Jude Medical, and Siemens, SigNum Preemptive Healthcare, Inc., Spectrum Dynamics, and Thermedical; speaking with an honorarium from Biotronik and MediaSphere Medical, LLC; receiving royalties from Wiley & Sons, Oxford, and St Jude Medical; Dr. Packer and Mayo Clinic jointly have equity in a privately held company, External Beam Ablation Medical Devices, outside the submitted work. Dr Packer has mapping technologies with royalties paid. Dr. Asirvatham has received honoraria for speaking from Boston Scientific, Biotronik, Medtronic, St. Jude Medical. He also has received Aegis-Consultant/Consulting fee. Other authors had no disclosures to report.

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Wen, S., Pislaru, C., Monahan, K.H. et al. Arrhythmia Recurrence After Atrial Fibrillation Ablation: Impact of Warfarin vs. Non-Vitamin K Antagonist Oral Anticoagulants. Cardiovasc Drugs Ther 36, 891–901 (2022). https://doi.org/10.1007/s10557-021-07200-3

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