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Patterns of Anticoagulation Use and Cardioembolic Risk After Catheter Ablation for Atrial Fibrillation.

Publication ,  Journal Article
Noseworthy, PA; Yao, X; Deshmukh, AJ; Van Houten, H; Sangaralingham, LR; Siontis, KC; Piccini, JP; Asirvatham, SJ; Friedman, PA; Packer, DL ...
Published in: J Am Heart Assoc
November 5, 2015

BACKGROUND: There is significant practice variation in oral anticoagulation (OAC) use following catheter ablation for atrial fibrillation. It is not clear whether the risk of cardioembolism increases after discontinuation of OAC following catheter ablation. METHODS AND RESULTS: We identified 6886 patients within a large national administrative claims database who underwent catheter ablation for atrial fibrillation between January 1, 2005, and September 30, 2014. We assessed the effect of time off of OAC by CHA2DS2-VASc score (after adjusting for other comorbidities) on risk of cardioembolism, using Cox proportional hazards models. There was an increase in the use of non-vitamin K OAC after ablation from 0% in 2005 to 69.8% in 2014. OAC discontinuation was high, with only 60.5% and 31.3% of patients remaining on OAC at 3 and 12 months, respectively. The rate of discontinuation was higher in low-risk patients (82% versus 62.5% at 12 months for CHA2DS2-VASc 0-1 versus ≥2, respectively; P<0.001). Stroke occurred in 1.4% of patients with CHA2DS2-VASc ≥2 and 0.3% of those with CHA2DS2-VASc 0 or 1 over the study follow-up. The risk of cardioembolism in the first 3 months after ablation was increased among those with any time off OAC (hazard ratio 8.06 [95% CI 1.53-42.3], P<0.05). The risk of cardioembolism beyond 3 months was increased with OAC discontinuation among high-risk patients (hazard ratio 2.48 [95% CI 1.11-5.52], P<0.05) but not low-risk patients. CONCLUSION: The overall risk of stroke in postablation patients is low; however, OAC discontinuation after ablation is common and is associated with increased risk of cardioembolism for all patients within the first 3 months and for high-risk patients in the long term. Continuing OAC for at least 3 months in all patients and indefinitely in high-risk patients appears to be the safest strategy.

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Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

November 5, 2015

Volume

4

Issue

11

Location

England

Related Subject Headings

  • Young Adult
  • United States
  • Treatment Outcome
  • Time Factors
  • Stroke
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Proportional Hazards Models
  • Practice Patterns, Physicians'
 

Citation

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Noseworthy, P. A., Yao, X., Deshmukh, A. J., Van Houten, H., Sangaralingham, L. R., Siontis, K. C., … Shah, N. D. (2015). Patterns of Anticoagulation Use and Cardioembolic Risk After Catheter Ablation for Atrial Fibrillation. J Am Heart Assoc, 4(11). https://doi.org/10.1161/JAHA.115.002597
Noseworthy, Peter A., Xiaoxi Yao, Abhishek J. Deshmukh, Holly Van Houten, Lindsey R. Sangaralingham, Konstantinos C. Siontis, Jonathan P. Piccini, et al. “Patterns of Anticoagulation Use and Cardioembolic Risk After Catheter Ablation for Atrial Fibrillation.J Am Heart Assoc 4, no. 11 (November 5, 2015). https://doi.org/10.1161/JAHA.115.002597.
Noseworthy PA, Yao X, Deshmukh AJ, Van Houten H, Sangaralingham LR, Siontis KC, et al. Patterns of Anticoagulation Use and Cardioembolic Risk After Catheter Ablation for Atrial Fibrillation. J Am Heart Assoc. 2015 Nov 5;4(11).
Noseworthy, Peter A., et al. “Patterns of Anticoagulation Use and Cardioembolic Risk After Catheter Ablation for Atrial Fibrillation.J Am Heart Assoc, vol. 4, no. 11, Nov. 2015. Pubmed, doi:10.1161/JAHA.115.002597.
Noseworthy PA, Yao X, Deshmukh AJ, Van Houten H, Sangaralingham LR, Siontis KC, Piccini JP, Asirvatham SJ, Friedman PA, Packer DL, Gersh BJ, Shah ND. Patterns of Anticoagulation Use and Cardioembolic Risk After Catheter Ablation for Atrial Fibrillation. J Am Heart Assoc. 2015 Nov 5;4(11).
Journal cover image

Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

November 5, 2015

Volume

4

Issue

11

Location

England

Related Subject Headings

  • Young Adult
  • United States
  • Treatment Outcome
  • Time Factors
  • Stroke
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Proportional Hazards Models
  • Practice Patterns, Physicians'