Risk of Stroke and Recurrence After AF Ablation in Patients With an Initial Event‐Free Period of 12 Months

Kochhäuser, Simon; Alipour, Pouria; Haig-Carter, Tanjah; Trought, Kathleen; Hache, Philip; Khaykin, Yaariv; Wulffhart, Zaev; Pantano, Alfredo; Tsang, Bernice; Birnie, David H.

doi:10.1111/jce.13138

Cited by 14 publications

(40 citation statements)

References 29 publications

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“…All but three studies had a blanking period of at least 3 months after catheter ablation before OAC was discontinued. The anticoagulation used was predominantly warfarin in all but three studies, which included patients on direct‐acting oral anticoagulants. In 12 studies, OAC was replaced by aspirin in the discontinuation group.…”

Section: Resultsmentioning

confidence: 99%

“…The anticoagulation used was predominantly warfarin in all but three studies, which included patients on direct‐acting oral anticoagulants. In 12 studies, OAC was replaced by aspirin in the discontinuation group. The main indication to stop OAC was the persistence of sinus rhythm and when reported OAC was generally restarted if AF recurred.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 16 studies reported this outcome . In one study, the number of events was zero in both groups and the risk ratio could not be calculated.…”

Section: Resultsmentioning

confidence: 99%

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Anticoagulation after catheter ablation of atrial fibrillation: An unnecessary evil? A systematic review and meta‐analysis

Proietti

AlTurki

Biase

et al. 2019

Cardiovasc electrophysiol

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Background Anticoagulation in patients with atrial fibrillation (AF) is currently based on clinical parameters (CHA2DS 2‐VASc score) that have been shown to predict cerebrovascular events (CVE). Controversy exists as to whether CVE risk persists unmodified after successful catheter ablation, as observational studies suggest a lower risk of CVE. Current guidelines recommend continued oral anticoagulation (OAC) based on the CHA 2DS 2‐VASc score risk profile. Methods We conducted a systematic literature review of all studies published up to July 31, 2018, that reported CVE after catheter ablation of AF and compared patients on or off OAC. Random‐effects models were used to demonstrate the risk of CVE and major bleeding in on‐OAC vs off‐OAC patients. This analysis was further stratified by CHADS2 and CHA 2DS 2‐VASc score. Results We retained 16 studies, 10 prospective cohort and 6 retrospective cohort, that met inclusion criteria, and which enrolled 25 177 patients: 13 166 off‐OAC and 12 011 on‐OAC. No significant difference in the incidence of CVE emerged between on‐OAC and off‐OAC patients after AF ablation (risk ratio, 0.66; confidence interval [CI], 0.38, 1.15). Similar results were found after stratification by CHADS2 and CHA 2DS 2‐VASc score. Off‐OAC patients suffered significantly less bleeding than those on OAC (RR, 0.17; CI, 0.09, 0.34). Of note, the percentage of patients with AF recurrence impacts the treatment effect in the two groups ( P = 0.001). Conclusions In this metanalysis, the risk‐benefit ratio favored the suspension of OAT after successful AF ablation even in patients at moderate‐high risk. Whether the reported results can be extended also to non‐vitamin K antagonist oral anticoagulants warrants further investigations.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Anticoagulation after catheter ablation of atrial fibrillation: An unnecessary evil? A systematic review and meta‐analysis

Proietti

AlTurki

Biase

et al. 2019

Cardiovasc electrophysiol

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“…Atrial fibrillation (AF) leads to a higher incidence of embolic stroke (ES) or thromboembolic event (TE) as compared with patients with sinus rhythm (SR) and oral anticoagulant reduces this risk . Some pieces of evidence suggest that effective rhythm control strategies, specifically catheter ablation (CA), may be useful to further reduce the risk of TE as well as the number of AF episodes . Nevertheless, how AF ablation may affect the risk of ES, and which risk factors can predict the occurrence of ES after AF ablation remain uncertain, especially in the Asian population.…”

Section: Introductionmentioning

confidence: 99%

“…Left atrial (LA) contractile and endothelial dysfunctions caused by progressive atrial fibrosis may lead to TE . In particular, the lack of direct evidence of a temporal relationship between AF episodes and TE in most patients suggests that atrial cardiomyopathy may underlie most ES and that AF could represent a marker of atrial cardiomyopathy . Furthermore, functional or structural remodeling of the LA after AF ablation interacts with the clinical risk factors through complex pathways which may contribute to the occurrence of ES during the post‐AF ablation period.…”

Section: Introductionmentioning

confidence: 99%

Association between epicardial adipose tissue and embolic stroke after catheter ablation of atrial fibrillation

Ahn

Shin

Shim

et al. 2019

Cardiovasc electrophysiol

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Introduction Risk factors of embolic stroke (ES) after atrial fibrillation (AF) ablation have not been fully elucidated especially among the Asian subjects, particularly regarding epicardial adipose tissue (EAT) in cardiac imaging. We aimed to assess the incidence of ES during a long‐term follow‐up period after AF ablation and to identify the risk factors associated with postablation ES, specifically focusing on EAT. Methods and Results We enrolled patients who experienced postablation ES and control subjects from a consortium of AF ablation registries from three institutes in Korea. EAT was assessed using multislice computed tomography before AF ablation. A total of 3464 patients who underwent AF ablation were recruited and followed‐up. During a follow‐up of 47.2 ± 36.4 months, ES occurred in 47 patients (1.36%) with a CHA2DS2‐VASc score of 1.48 ± 1.39 and the overall annual incidence of ES was 0.34%. Compared with the control group (n = 190), the ES group showed significantly higher prior thromboembolism (TE) and AF recurrence rates, larger left atrium size, lower creatinine clearance rate (CCr), and greater total and peri‐atrial EAT volume. Multivariate regression analysis demonstrated larger peri‐atrial EAT volume (hazards ratio, 1.065; 95% confidence interval, 1.005‐1.128), in addition to a prior history of TE and lower CCr, was independently associated with postablation ES. When a cut‐off value of peri‐atrial EAT volume of ≥20.15 mL was applied, patients with smaller peri‐atrial EAT volume showed significantly higher ES‐free survival. Conclusion Larger peri‐atrial EAT volume, in addition to prior TE and lower CCr, was independently associated with postablation ES regardless of AF recurrence and CHA2DS2‐VASc score. (ClinicalTrials.gov number, NCT03479073).

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Long-term incidence and predictive factors of thromboembolic events after a cryoballoon ablation for atrial fibrillation

Hermida

Zaitouni

Lallemand

et al. 2020

International Journal of Cardiology

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Risk of Stroke and Recurrence After AF Ablation in Patients With an Initial Event‐Free Period of 12 Months

Abstract: The overall risk of stroke and AF recurrence is low in patients with a recurrence free interval of at least 12 months after AF ablation. Of note, recurrence of AF was not associated with a higher risk of stroke in our study population.

Cited by 14 publications

References 29 publications

Anticoagulation after catheter ablation of atrial fibrillation: An unnecessary evil? A systematic review and meta‐analysis

Anticoagulation after catheter ablation of atrial fibrillation: An unnecessary evil? A systematic review and meta‐analysis

Association between epicardial adipose tissue and embolic stroke after catheter ablation of atrial fibrillation

Long-term incidence and predictive factors of thromboembolic events after a cryoballoon ablation for atrial fibrillation

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