Current Status and Clinical Outcomes of Oral Anticoagulant Discontinuation After Ablation for Atrial Fibrillation in Japan　― Findings From the AF Frontier Ablation Registry ―

Abstract

rence, 2,3 and thus might yield improved clinical outcomes in terms of ischemic stroke, heart failure, and death. For patients in whom PVI is truly curative, it should be possible to discontinue oral anticoagulants (OACs) without fear that an AF-related clinical event will occur. Despite A trial fibrillation (AF) affects quality of life and increases the risks of stroke, heart failure, and death. 1 Pulmonary vein isolation (PVI) is reported to be more effective than antiarrhythmic drug (AAD) therapy for relief of symptoms and freedom from AF recur

Different Determinants of the Recurrence of Atrial Fibrillation and Adverse Clinical Events in the Mid-Term Period After Atrial Fibrillation Ablation

“…The 3,530 patients who underwent AF catheter ablation at 24 cardiovascular centers in Japan were enrolled in August 2011 and followed up until July 2017 (UMIN Clinical Trials Registry: UMIN000026849). 13 Data of consecutive patients (median number: 100 [range 47-443] patients) were collected in each center, amounting to 3,530 patients. Of these, 79 were lost to follow-up, leaving a total of 3,451 for inclusion in this study.…”

Clinical Outcomes of Off-Label Underdosing of Direct Oral Anticoagulants After Ablation for Atrial Fibrillation

“…Further, we showed previously that patients for whom DOACs were discontinued, in comparison to those for whom DOACs were continued, were relatively young (60.9 ± 10.4 years), had relatively low CHA2DS2-VASC scores (1.5 ± 1.2), and suffered AF recurrence at a relatively low rate (16.3%), resulting in a relatively low incidence of adverse events. 4) The annual incidences of stroke, major bleeding, and death in the DOAC discontinuation group were 0.4%/year, 0.8%/year, and 0.2%/year, respectively, and were similar to those in the off-label underdose group. Finally, our evaluation of the effects of the three different DOAC dosing regimens should be considered with caution because of the relatively low overall incidence of clinical events and short follow-up period.…”

“…All 3530 patients had been enrolled in the Atrial Fibrillation registry to Follow the long-teRm Outcomes and use of aNTIcoagulants aftER Ablation (AF Frontier Ablation Registry; UMIN Clinical Trials Registry: UMIN000026849). 4) Seventy-nine of the total patients were lost to follow-up, leaving, for possible inclusion in the study, a total of 3451 patients who had been followed up for at least 12 months. Of those 3451 patients, 2698 were DOAC users.…”

“…Theoretically, in cases in which PVI is truly curative, OACs can be stopped, but analysis of real-world data obtained from a Japanese patient registry showed that OACs were continued for about half of the patients under consideration of their risk for stroke and/or AF recurrence. 4) The decision on whether or not to use an OAC after ablation is made at the physician's discretion, but not without an understanding of the patient's preference. One concern pertains to use of direct OACs (DOACs): overdosing can lead to major bleeding, whereas underdosing can lead to stroke.…”

Impact of Sinus Rhythm Maintenance on Major Adverse Cardiac and Cerebrovascular Events after Catheter Ablation of Atrial Fibrillation: Insights from AF Frontier Ablation Registry

“…The AF Frontier Ablation Registry (UMIN Clinical Trials Registry: UMIN000026849) is a multicenter cohort study whose study design has previously been described in detail. 9 Briefly, the study included 3530 consecutive patients who underwent catheter ablation for AF at any of the 24 cardiovascular centers in Japan between August 2011 and July 2017. The clinical data, such as patient characteristics (e.g., age, sex, AF type, comorbidities, blood test results, echocardiographic characteristics, and drugs), catheter ablation findings, and follow-up data were retrieved from each hospital's medical records.…”