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Oral Anticoagulation Discontinuation Following Catheter Ablation of Typical Atrial Flutter

Catheter ablation (CA) of typical atrial flutter (AFL) is the preferred treatment for typical AFL due to its excellent long-term success rate. However, current guidelines recommend pursuing oral anticoagulation (OAC) based on established indices of stroke regardless of the perceived success of ablat...

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Autores principales: Alqam, Bilal M., Von Edwins, Kirby N., Devabhaktuni, Subodh, Paydak, Hakan, Pothineni, Naga Venkata K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MediaSphere Medical 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8313186/
https://www.ncbi.nlm.nih.gov/pubmed/34327045
http://dx.doi.org/10.19102/icrm.2021.120703
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author Alqam, Bilal M.
Von Edwins, Kirby N.
Devabhaktuni, Subodh
Paydak, Hakan
Pothineni, Naga Venkata K.
author_facet Alqam, Bilal M.
Von Edwins, Kirby N.
Devabhaktuni, Subodh
Paydak, Hakan
Pothineni, Naga Venkata K.
author_sort Alqam, Bilal M.
collection PubMed
description Catheter ablation (CA) of typical atrial flutter (AFL) is the preferred treatment for typical AFL due to its excellent long-term success rate. However, current guidelines recommend pursuing oral anticoagulation (OAC) based on established indices of stroke regardless of the perceived success of ablation. We conducted a retrospective study of all patients who underwent typical AFL ablation at our institute from 2011 to 2017. All patients continued OAC for at least six weeks post-CA and underwent 24-hour Holter monitoring. OAC was discontinued if there was no evidence of recurrence at six weeks. In patients with low left ventricular ejection fraction or prior atrial fibrillation episodes, OAC was continued for six months with repeat Holter monitoring at six months. A total of 106 patients were included in our analysis, with a mean age of 64 ± 14 years and 78.3% of whom were male. The mean CHA(2)DS(2)-VASc score was 3 ± 1 points. OAC was discontinued by six weeks in 17% and at one year in 55.7% of patients, respectively, but was continued indefinitely in 44.3%. Over a mean follow-up period of 28.6 ± 27.3 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 three major bleeding events, all in the OAC group. In patients undergoing successful AFL ablation, a strategy of OAC discontinuation with close rhythm monitoring appears feasible. The benefit of continued OAC in this cohort may be outweighed by an adverse risk of bleeding. Further studies examining rhythm-guided OAC can minimize unnecessary exposure to long-term anticoagulation.
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spelling pubmed-83131862021-07-28 Oral Anticoagulation Discontinuation Following Catheter Ablation of Typical Atrial Flutter Alqam, Bilal M. Von Edwins, Kirby N. Devabhaktuni, Subodh Paydak, Hakan Pothineni, Naga Venkata K. J Innov Card Rhythm Manag Original Research Catheter ablation (CA) of typical atrial flutter (AFL) is the preferred treatment for typical AFL due to its excellent long-term success rate. However, current guidelines recommend pursuing oral anticoagulation (OAC) based on established indices of stroke regardless of the perceived success of ablation. We conducted a retrospective study of all patients who underwent typical AFL ablation at our institute from 2011 to 2017. All patients continued OAC for at least six weeks post-CA and underwent 24-hour Holter monitoring. OAC was discontinued if there was no evidence of recurrence at six weeks. In patients with low left ventricular ejection fraction or prior atrial fibrillation episodes, OAC was continued for six months with repeat Holter monitoring at six months. A total of 106 patients were included in our analysis, with a mean age of 64 ± 14 years and 78.3% of whom were male. The mean CHA(2)DS(2)-VASc score was 3 ± 1 points. OAC was discontinued by six weeks in 17% and at one year in 55.7% of patients, respectively, but was continued indefinitely in 44.3%. Over a mean follow-up period of 28.6 ± 27.3 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 three major bleeding events, all in the OAC group. In patients undergoing successful AFL ablation, a strategy of OAC discontinuation with close rhythm monitoring appears feasible. The benefit of continued OAC in this cohort may be outweighed by an adverse risk of bleeding. Further studies examining rhythm-guided OAC can minimize unnecessary exposure to long-term anticoagulation. MediaSphere Medical 2021-07-15 /pmc/articles/PMC8313186/ /pubmed/34327045 http://dx.doi.org/10.19102/icrm.2021.120703 Text en Copyright: © 2021 Innovations in Cardiac Rhythm Management https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research
Alqam, Bilal M.
Von Edwins, Kirby N.
Devabhaktuni, Subodh
Paydak, Hakan
Pothineni, Naga Venkata K.
Oral Anticoagulation Discontinuation Following Catheter Ablation of Typical Atrial Flutter
title Oral Anticoagulation Discontinuation Following Catheter Ablation of Typical Atrial Flutter
title_full Oral Anticoagulation Discontinuation Following Catheter Ablation of Typical Atrial Flutter
title_fullStr Oral Anticoagulation Discontinuation Following Catheter Ablation of Typical Atrial Flutter
title_full_unstemmed Oral Anticoagulation Discontinuation Following Catheter Ablation of Typical Atrial Flutter
title_short Oral Anticoagulation Discontinuation Following Catheter Ablation of Typical Atrial Flutter
title_sort oral anticoagulation discontinuation following catheter ablation of typical atrial flutter
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8313186/
https://www.ncbi.nlm.nih.gov/pubmed/34327045
http://dx.doi.org/10.19102/icrm.2021.120703
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