Incidence of cerebral thromboembolic events during long-term follow-up in patients treated with transcatheter ablation for atrial fibrillation

Net clinical benefit of long-term oral anticoagulation therapy (OAT) continuation after successful atrial fibrillation (AF) ablation is still controversial. To evaluate long-term thromboembolic (TE) and haemorrhagic events incidence according to OAT strategy used after AF transcatheter ablation.

Three months after AF ablation, OAT was discontinued in patients with CHADS₂ ≤ 1 if no recurrences were documented, while OAT was maintained in patients with CHADS₂ ≥ 2 regardless of AF recurrences. CHA₂DS₂VASc and HAS-BLED scores have been retrospectively evaluated. Seven hundred and sixty-six patients were followed for a median of 60.5 months. Six (6/267 = 2.2%) and five (5/499 = 1%) TE events occurred in the ON and the OFF-OAT patients, respectively (P = 0.145), all in concomitance with the AF recurrence. CHADS₂ and CHA₂DS₂VASc ≥ 2 were associated with high TE incidence (P = 0.047 and P = 0.020). Among patients with a CHADS₂ score of 0 or 1, a CHA₂DS₂VASc score ≥ 2 was predictive of TE events (P = 0.014). Overall, the incidence of the TE events in patients with CHA₂DS₂VASc ≥ 2 was 0.6 per 100 patient-years whereas seven haemorrhagic events occurred, all of them in the ON-OAT patients (7/267 = 2.6%).

Patients with AF undergoing transcatheter ablation have a lower incidence of TE events as compared with the general AF population, regardless of OAT maintenance. The unpredictable risk of AF recurrence, mandate the routine use of the CHADS₂, CHA₂DS₂VASc, and HAS-BLED scores to guide clinical decision regarding OAT management in this peculiar setting of patients. The potential protective role of rhythm control strategy in the TE events needs to be confirmed by future large randomized trials.