Abstract 4141879: Post-procedure oral anticoagulation following pulsed-field ablation for atrial fibrillation

Background: Current guidelines recommend oral anticoagulation (OAC) for at least two months post-radiofrequency ablation (RFA) in all patients with atrial fibrillation (AF). The endothelial injury during RFA that can promote thrombus formation, does not happen in pulsed-field ablation (PFA). Objective: We evaluated the optimal duration of OAC therapy needed for effective stroke prevention following PFA. Methods: Consecutive patients undergoing PFA for AF were included in the study and prospectively followed-up for 1 year. Based on the duration of post-ablation OAC [non-vitamin K OAC (NOAC)] therapy they were classified into group 1: NOAC for 1 month and group 2: NOAC for ≥2 months. Patients were closely monitored for thromboembolic (TE) events via telemedicine. Stroke/transient ischemic attacks that occurred while the patients were in full compliance with the anti-thrombotic therapy, were counted as the reportable TE events. Results: A total of 120 patients were included in this analysis. The mean age of the study population was 59.80 ± 16.39 years; 70 (58%) were male and the CHA 2 DS 2 -VASc score was 4.27 ± 1.22. Mean number of PFA applications given was 76.64 ± 36.04. G roup 1 included 49 (40.8%) and group 2 was comprised of 71 (59.2%) patients. Baseline characteristics were comparable between the groups. At 1 year, no stroke or transient ischemic attacks were reported in group 1 and 2 . At that time point, 42 (85.7%) and 60 (84.5%) patients were arrhythmia-free in group 1 and 2 respectively (p=0.85). Conclusion: In this series of patients, OAC could be safely discontinued after 1 month following the PFA procedure. Thus, it seems redundant to continue OAC beyond 1 month after PFA.