When Does High Risk for Stroke Become Low Risk After Atrial Fibrillation Ablation?

Anticoagulation use and clinical outcomes after catheter ablation in patients with persistent and longstanding persistent atrial fibrillation

“…However, the decision to discontinue OAT was permitted in selected patients (based on their values and preferences) only if they were felt to be at low risk for CVE after AF ablation. The informal consensus among providers at our institution discourages discontinuation in patients with a prior history of stroke or TIA, patients with a large preablation left atrium (LA) (diameter > 5 cm) or in whom LA diameter remains dilated after ablation, and patients who continue to have evidence of spontaneous echocardiographic contrast . OAT discontinuation is also discouraged in patients who have documented AF recurrence or who are unable or unwilling to regularly assess their pulse and undergo routine monitoring to identify asymptomatic AF episodes.…”

Oral anticoagulation after catheter ablation of atrial fibrillation and the associated risk of thromboembolic events and intracranial hemorrhage: A systematic review and meta‐analysis

“…Continuation of OAC after the blanking period of CA of AF is controversial because some studies suggest that the risk of major bleeding events (MBE), especially intracranial hemorrhage (ICH), outweigh the benefits of OAC after a successful CA and that OAC can be safely discontinued in carefully selected patients without recurrence of AF regardless of their individual CHADS 2 score . Although, some experts question the use of long‐term OAC after successful CA . The current guidelines, based on expert consensus, recommend that decisions regarding OAC in patients post‐CA should be made based on the individualized stroke risk and not on the apparent success of the procedure.…”