Discussion:
In this single center observational study, a strategy of OAC
discontinuation with serial rhythm monitoring following successful AFl
ablation appears to be safe and feasible. OAC discontinuation was
associated with a significant reduction in major bleeding events with no
increase is ischemic adverse events. This is consistent with previous
studies reporting a low incidence of ischemic stroke (0.07%) among
patients who stopped OAC after successful AF ablation2
A major reason for continued OAC following AFl ablation is the
occurrence of AF, with incidence of AF ranging up to
50%3. AF occurring post AFl ablation can increase
long term stroke risk.4. However, majority of these
occurrences are usually in patients with a prior history of AF or LV
dysfunction5. This was apparent in our experience as
well where 44.3% of patients were on continued OAC with the predominant
reason being a prior or new diagnosis of AF.
Our study is limited by its retrospective nature. Absence of continuous
monitoring may also have led to under-recognition of asymptomatic or
intermittent episodes of AF. Using insertable cardiac monitors can
potentially guide OAC decisions and present an attractive venue for
targeted OAC. In summary, we report successful OAC discontinuation in
approximately half of our patient undergoing successful AFl ablation
without an increased risk of ischemic complications. Further studies
examining rhythm guided OAC can minimize unnecessary exposure to long
term anticoagulants.