Long-term outcome and risk factors associated with events in patients with atrial fibrillation treated with oral anticoagulants: The ASSAF-K registry

Association between oral anticoagulants continuation on thromboembolism and bleeding events in patients with CHADS2 score 0-2 points after catheter ablation for persistent atrial fibrillation

BACKGROUND

Guidelines state that oral anticoagulants (OACs) should be continued after catheter ablation for atrial fibrillation (AF) based on thromboembolic risk stratification, regardless of procedural results. However, whether OACs could be discontinued in low-thromboembolic-risk patients remains unclear.

METHODS

This was a retrospective follow-up study from the EARNEST-PVI (NCT03514693) trial, which compared the efficacy of pulmonary vein isolation (PVI)-alone and PVI-plus strategies for persistent AF ablation. A total of 427 patients with CHADS2 score of ≤2 points were divided into two groups: OAC continuation throughout the overall period (group C, n = 205) and OAC discontinuation within 1 year after ablation (group D, n = 222). The incidence of thromboembolic and bleeding events was analyzed.

RESULTS

AF recurrence (33 % vs. 17 %, p < 0.001), thromboembolic events (1.39 % vs. 0 % per year, p = 0.005), and overall bleeding event rates (7.54 % vs. 3.32 % per year, p = 0.003) were higher in group C than in group D. There was no significant difference in major bleeding event rates between the C and D groups (0.51 % vs. 0.67 % per year, p = 0.686). However, a higher number of overall bleeding events, including major and clinically relevant non-major events, was observed in group C (adjusted hazards ratio: 2.04, 95 % confidence interval: 1.14-3.65, p = 0.016).

CONCLUSIONS

Thromboembolic events and overall bleeding events were fewer in the OAC discontinuation group compared with the OAC continuation group. Discontinuation of OACs might be considered in patients with low CHADS2 score after catheter ablation of persistent AF.

Enhancing Digital Health Interventions for Medication Adherence: Considerations for Broader Applicability and Long-Term Impact

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Adverse Events Requiring Hospitalization Following Catheter Ablation for Atrial Fibrillation in Heart Failure with versus without Systolic Dysfunction

BACKGROUND

The safety and efficacy of atrial fibrillation (AF) ablation in individuals with heart failure (HF) with preserved ejection fraction (EF), particularly concerning the occurrence of post-procedural adverse events necessitating hospitalization, including anticoagulant-associated major bleeding, still lack conclusive determination.

METHODS

Data from patients with HF and AF who underwent catheter ablation for AF between 2019 and 2022 at our institution were retrospectively reviewed. All participants were divided into an EF < 50% group or an EF ≥ 50% group according to their baseline left ventricular EF. The composite incidence of the clinical events following catheter ablation was compared between the two groups: (1) all-cause death, (2) HF hospitalization, (3) stroke or systemic embolism, and (4) major bleeding.

RESULTS

A total of 122 patients (75 years old, 68 male) were included. Of them, 62 (50.8%) patients had an EF ≥ 50%. EF ≥ 50% was an independent predictor of the composite endpoint (adjusted odds ratio 6.07, 95% confidence interval 1.37-26.99, p = 0.018). The incidences of each adverse event were not significantly different between the two groups, except for a higher incidence of major bleeding in the EF ≥ 50% group (12.7% vs. 0%, p = 0.026).

CONCLUSIONS

Among patients with HF coupled with AF, the incidence of adverse events following AF ablation proved notably elevated in patients with EF ≥ 50% in contrast to their counterparts with EF < 50%. This disparity primarily stems from a heightened occurrence of major bleeding within the EF ≥ 50% cohort. The strategy to reduce adverse events, especially in patients with EF ≥ 50%, remains the next concern.