Role of anticoagulation therapy after pulmonary vein antrum isolation for atrial fibrillation treatment

Department of Cardiology, Umberto I Hospital, Mestre-Venice, Italy.
Journal of Cardiovascular Medicine (Impact Factor: 1.51). 02/2008; 9(1):51-5. DOI: 10.2459/JCM.0b013e32801462d4
Source: PubMed


Atrial fibrillation (AF) increases the risk of atrioembolic stroke. However, the role of anticoagulation therapy (OAT) in preventing cerebrovascular accidents (CVA) after intracardiac echocardiography-guided pulmonary vein antrum isolation (ICE-PVAI) is still unclear. In the present study, we evaluated the incidence of CVA following the interruption of OAT 3 months after ICE-PVAI.
Between September 2002 and March 2004, 85 consecutive patients (72 men, mean age 62 +/- 7 years) underwent ICE-PVAI for symptomatic drug-refractory AF. Heart disease was present in 61 patients (72%) (left ventricular ejection fraction = 58 +/- 6%, LA diameter 44 +/- 6 mm). Eighty-five consecutive patients who underwent electrical cardioversion (EC) for AF, matched for age, sex and heart disease, served as a control group. After 3 months, OAT was stopped unless one of the following conditions was observed: (i) AF-recurrence; (ii) severe pulmonary vein stenosis; (iii) non-good atrial contractility on transesophageal echocardiography; or (iv) other indications for OAT.
In the study group, OAT was stopped after 3 months in 77 patients (90%) and no CVA occurred during the remaining follow-up (15 +/- 7 months). In the control group, 1 month after EC, OAT was stopped by the referring physician in 29 patients (34%). A stroke occurred in five patients (6%) (P = 0.09; mean P = 0.059) during follow-up. In two of these (2%), the stroke was fatal.
Stopping OAT 3 months after ICE-PVAI seems to be safe in patients without AF recurrences after the first 3 months following ablation. Further randomized-controlled studies are needed to confirm these preliminary data.

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    • "Rossillo et al. studied patients after catheter ablation and stopped the anticoagulation therapy in patients that were without AF recurrences after the first 3 months following ablation. They could show that those patients had no cerebrovascular accidents within the follow-up (15 ± 7 months) [38]. Another recent study could show that AF ablation patients had a significantly lower risk of stroke compared to AF patients who did not undergo ablation independent of the baseline CHADS score. "
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