Exploring the feasibility of discontinuing oral anticoagulant therapy in post-ablation atrial fibrillation patients with low stroke risk: a conceptual inquiry

Abstract Introduction Deciding to discontinue oral anticoagulation (OAC) necessitates a detailed assessment of individual risk factors. This study aims to confirm the viability of discontinuing OAC in patients undergoing atrial fibrillation ablation with a low CHA2DS2-VASC score and a cardiac implantable electronic device (CIED) with continuous monitoring as a primary concept. Method In this prospective single-center observational study, all patients with a low CHA2DS2-VASc score of 1-2, who underwent pulmonary vein isolation and had continuous monitoring via CIED, were enrolled. To discontinue oral anticoagulation, patients had to meet the criteria outlined in our institution's standard protocol. Follow-up was conducted using surveillance through our telemedicine center. Results 298 patients with a mean age of 60 ± 8.9 years and a median CHA2DS2-VASc score of 2 were included. 117 patients (39.3%) temporarily stopped their oral anticoagulation therapy, while 181 patients (60.7%) continued their anticoagulation treatment. Over a 3.5-year follow-up, 62.4% of patients in the discontinuation group remained AF-free for episodes lasting over 6 minutes and were able to discontinue their medication for 3,5 years. Importantly, there was no statistically significant difference in the occurrence of relevant strokes between the two groups (discontinuation group vs. continuation group: (OR, 0.25; confidence interval 96% [CI], 0.029-2.11; p=0.175) during the follow-up period. Notably, patients in the discontinuation group had a lower stroke risk of 0.24 per 100 patient-years compared to the continuation group, which had a stroke risk of 1.03 per 100 patient-years. Conclusion In conclusion, our study shows that stopping oral anticoagulation in atrial fibrillation ablation patients with a low CHA2DS2-VASc score and continuous monitoring is safe. Individualized risk assessment and monitoring, following our protocol, could aid in discontinuing OAC in select patients.