Stopping Oral Anticoagulation Reduces Risk After Successful Atrial Fibrillation Ablation

Discontinuing oral anticoagulation (OAC) therapy resulted successful a little consequence of a composite of stroke, systemic embolism aliases awesome bleeding than continuing OAC therapy successful patients who had successful ablation for atrial fibrillation astatine slightest 12 months previously, according to results from a late-breaking proceedings presented successful a Hot Line convention coming astatine ESC Congress 2025 and simultaneously published successful The Journal of nan American Medical Association.

Atrial fibrillation (AF) is simply a communal type of arrhythmia characterised by an abnormal irregular heartbeat that tin summation nan consequence of changeable and thromboembolism (blood clots). Ablation tin beryllium utilized to destruct mini sections of bosom insubstantial that whitethorn beryllium causing abnormal heartbeats. Oral anticoagulation (OAC) is recommended successful each patients for astatine slightest 2 months aft AF ablation to trim nan consequence of changeable aliases thromboembolism. Thereafter, guidelines urge continuing OAC depending connected nan patient's consequence of stroke.

Explaining why nan ALONE-AF proceedings was conducted, its Principal Investigator, Professor Boyoung Joung from Yonsei University, Seoul, South Korea, said: "Many patients who person had a successful ablation and person changeable consequence factors stay connected OAC for nan remainder of their lives, though location is nary grounds from randomized tests to bespeak that this is necessary. We compared nonstop OAC therapy pinch nary OAC therapy among patients 1 twelvemonth aft successful AF ablation who had astatine slightest 1 consequence facet for stroke."

The ALONE-AF proceedings was an open-label randomized superiority proceedings conducted astatine 18 sites successful South Korea. Eligible patients had non-valvular AF, had undergone their first catheter-based AF ablation, had nary atrial arrhythmia recurrence for astatine slightest 12 months post-ablation and had astatine slightest 1 changeable consequence facet arsenic wished by nan CHA2DS2-VASc people (CHA2DS2-VASc ≥1 for males aliases ≥2 for females). Patients were randomized 1:1 to person nonstop OAC aliases nary OAC therapy. Patients randomized to nan OAC group received modular doses of apixaban, rivaroxaban aliases edoxaban, unless established dose-reduction criteria applied. The superior endpoint of nett adverse objective events was a composite of stroke, systemic embolism and awesome bleeding astatine 24 months.

The study organization included 840 randomized patients who had a mean property of 64 years, pinch one-quarter (25%) being women.

At 24 months, OAC was associated pinch a higher consequence of nett adverse objective events than nary OAC (2.2% vs. 0.3%; absolute quality −1.9%; 95% assurance interval [CI] −3.5 to −0.3; log-rank p=0.024).

No important quality was observed successful nan incidence of ischaemic changeable aliases systemic embolism astatine 24 months betwixt nan OAC and no-OAC groups (0.8% vs. 0.3%, respectively; absolute quality −0.5%; 95% CI −1.6 to 0.6). Major bleeding occurred successful 1.4% of patients successful nan OAC group and 0% successful nan no-OAC group (absolute quality -1.4%; 95% CI −2.6 to −0.2).

Concluding, Professor Joung said: "In nan first randomized proceedings to reside this question, receiving nary OAC curen resulted successful a little consequence of harmful events than OAC treatment. A limitation was that nan proceedings was not designed to observe a imaginable quality successful ischemic events, which occurred astatine a lower-than-expected rate. Our findings bespeak that lifelong OAC mightiness not beryllium basal successful each patients who person had successful AF ablation astatine slightest 1 twelvemonth previously. "