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.