Clinical Electrophysiology -> Atrial Fibrillation & Atrial Flutter: -> Pharmacology (Antiarrhythmic drugs and anticoagulants) D-PO02 - Poster Session II (ID 47) Poster

D-PO02-227 - Outcomes Of Anticoagulation Management Guided By An Implantable Loop Recorder Following Catheter Ablation Of Atrial Fibrillation (ID 265)


Background: Guidelines advocate continued oral anticoagulation (OAC) following catheter ablation of atrial fibrillation (AF) in patients (pts) at a high risk of stroke. However, current implantable loop recorders (ILRs) can automatically detect AF daily. Thus, a “pill-in-the-pocket” approach in these pts has been advocated.
Objective: To determine outcomes of post AF ablation pts in whom long-term OAC use was guided by ILRs.
Methods: We enrolled consecutive pts with AF and CHA2DS2-VASc ≥ 1 who had undergone AF ablation and had an ILR. Pts with prior stroke were excluded. Daily ECG data was adjudicated. Three months post-ablation OAC was stopped in all pts confirmed free of AF and not restarted unless there was AF recurrence. The cohort was then categorized into three groups: anticoagulation remained discontinued (ACDC), anticoagulation discontinued but then restarted (ACDC + Restart) due to AF recurrence, and anticoagulated continuously (AC) because of continued AF.
Results: The study cohort included 176 pts (66 ± 10 years, 59% male, 2.5 ± 1.3 CHA2DS2-VASc) who were followed for a mean of 611 ± 539 days. No pts experienced a TIA or stroke. OAC remained permanently off in 74 (42%) pts; had to be restarted in 34 (19%) pts and could never be stopped in 68 (39%) pts (Figure). Pts in whom OAC remained off were younger, had lower CHA2DS2-VASc score and more likely to have paroxysmal AF (Figure).
Conclusion: Our data show that an ILR guided strategy post-AF ablation allowed 42% of pts to remain off OAC during nearly 2 years of follow-up. During this time, no stroke events were observed. While longer-term follow-up data are needed, it appears that in may be possible to use this strategy in certain post AF ablation pts.