科研之友
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摘要
This study was conducted to examine the outcomes in patients with prior stroke/transient ischemic attack (CVA/TIA) after atrial fibrillation (AF) ablation and the feasibility of discontinuing oral anticoagulation (OAC).
This study examined long-term outcomes following AF ablations in 108 patients with a history of prior thromboembolic CVA/TIA. Because of risks of OAC, we frequently discontinue OAC in these patients after successful ablation. These patients understand the risks/benefits of discontinuing OAC and remain on OAC for a longer time following successful AF ablation, compared to our patients without prior CVA/TIA.
Patient age was 66.2 +/- 9.0 years with an average CHADS(2) score = 3.0 +/- 0.9 and CHA(2)DS(2)-VASc score = 4.1 +/- 1.4. Following 1.24 ablations, 71 (65.7 %) patients were AF free 2.8 +/- 1.6 (median 2.3) years after their last ablation. OAC was discontinued in 55/71 (77.5 %) patients an average of 7.3 months following the final ablation. These 55 patients had 2.2 +/- 1.3 (median 1.8) years of follow-up off of OAC. Kaplan-Meier analysis suggests little AF recurrence > 1 year following initial or final ablations, suggesting that 1 year post successful ablation may be the appropriate time to consider discontinuing OAC. Thirty-seven patients had AF postablation, and 32/37 (86.5 %) remained on OAC. One patient with a mechanical valve had a stroke despite OAC. Bleeding occurred in 8.3 % of patients on OAC and 0 % of patients off OAC (P = 0.027).
Patients with prior CVA/TIAs, who undergo successful AF ablation, have a low incidence of subsequent thromboembolic events. Most patients who appear AF free postablation may be able to discontinue OAC after successful ablation with a low thromboembolic risk and with a reduced bleeding risk.
- 出版日期2013-12
