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

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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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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

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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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Authors and Affiliations

  1. Department of Cardiology and Electrophysiology, University Heart Center, Martinistraße 52, 20246, Hamburg, Germany

    Jana Mareike Nührich, Daniel Steven, Stephan Willems & Boris A. Hoffmann

  2. Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany

    Karl-Heinz Kuck

  3. Department of Cardiology, Vivantes Hospital, Berlin, Germany

    Dietrich Andresen

  4. Praxisklinik Herz und Gefäße, Dresden, Germany

    Stefan G. Spitzer

  5. Department of Cardiology, Municipal Hospital Bogenhausen, Munich, Germany

    Ellen Hoffmann

  6. Westpfalz-Klinikum, Kaiserslautern, Germany

    Burghard Schumacher

  7. Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital, Muenster, Germany

    Lars Eckardt

  8. Department of Cardiology, Hospital Coburg, Coburg, Germany

    Johannes Brachmann

  9. Isar Heart Centre Munich, Munich, Germany

    Thorsten Lewalter

  10. Institute for Research in Myocardial Infarction, Ludwigshafen, Germany

    Matthias Hochadel & Jochen Senges

Authors
  1. Jana Mareike Nührich
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  2. Karl-Heinz Kuck
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  12. Jochen Senges
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  13. Stephan Willems
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  14. Boris A. Hoffmann
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Correspondence to Jana Mareike Nührich.

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Nührich, J.M., Kuck, KH., Andresen, D. et al. Oral anticoagulation is frequently discontinued after ablation of paroxysmal atrial fibrillation despite previous stroke: data from the German Ablation Registry. Clin Res Cardiol 104, 463–470 (2015). https://doi.org/10.1007/s00392-014-0804-1

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  • DOI: https://doi.org/10.1007/s00392-014-0804-1

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