Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Quality Measures & Complications D-PO05 - Poster Session V (ID 39) Poster

D-PO05-142 - Outcomes Of Oral Anticoagulation Discontinuation Following Typical Atrial Flutter Ablation (ID 565)

 K.N. Von Edwins: Nothing relevant to disclose.
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Background: Catheter ablation (CA) of typical atrial flutter (AFL) has high success and low complications rates. However, current guidelines recommend continued oral anticoagulation (OAC) even after successful ablation of AFL.
Objective: To evaluate a strategy of OAC discontinuation following typical AFL ablation.
Methods: We identified all patients who underwent typical AFL ablation at our institute between January 2011 and September 2017. All patients continued OAC for at least 4 weeks post CA and underwent 24 hour Holter monitoring 4-6 weeks after the procedure. OAC was discontinued if there was no evidence of recurrence at 6 weeks. In patients with low left ventricular ejection fraction (LVEF) and prior history of atrial fibrillation (AF), OAC was continued for 6 months with repeat Holter monitoring at 6 months.
Results: A total of 112 patients were included in our analysis; mean age was 64±13 years, 77% were male, and mean CHADSVaSC score was 3±1. OAC used post procedure was warfarin in 42.9% and a DOAC in 57.1%. 89.3% underwent Holter monitoring 4-6 weeks after the procedure and 21.4% at 6 months. OAC was discontinued by 6 weeks in 36.6% and at 6 months in 59.8%. OAC was continued indefinitely in 40.2%; of those patients, none had recurrence of typical AFL. 31.1% had occurrence of atypical AFL, and 46.7% developed new AF during follow up. Over a mean follow up period of 32±21 months, there was one ischemic stroke in the OAC discontinuation group and no ischemic events in the continued OAC group. There were a total of 8 major bleeding events, 7 in the OAC group and 1 in the OAC discontinuation group.
Conclusion: In patients undergoing successful typical AFL ablation, a strategy of OAC discontinuation with close rhythm monitoring appears feasible. Benefit of continued OAC in this cohort may be outweighed by the adverse risk of bleeding. Further randomized studies are needed to validate this approach.