anticoagulation after ablation for symptomatic paroxysmal a-Fib.

Posted by yoanne @yoanne, Feb 9, 2017

8 months ago I started a discussion about the need for anticoagulation after an ablation for a-Fib. I still don’t know, how american cardiologists handle this question.but maybe the following informations are helpful.
An ablation can be done as a catheter ablation or in connection with a heart valve operation. then it is called a surgical ablation. I had a mitral valve repair, so a surgical ablation was done.
I had oral anticoagulation for 6 months, because of the ingrown of the prosthetic ring around the valve. afterwards I was thinking about the need for further anticoagulation, considering the risk of recurrence of a-Fib’s in spite of the ablation. discussions with physicians were not helpful, literature reading as well.
I found by chance a recent article in a journal edited by the heart center of the cologne university. he, a cardiologist and electrophysiology expert, described the option of stopping anticoagulation depending on the underlying diseases.
I will confine myself to the group I belong to, i.e. ablation after symptomatic paroxysmal a-Fib. the problem is, that patients, like me, would say, that the ablation was succesful. until now I believe that I had no a-Fib’s lasting longer than 30 seconds. but maybe a strict monitoring would show me several very short a-Fib’s.
in his article he suggested the patients with a score of 2 or less (CHA2DS2-VASc) to have a 24 hours electrocardiography once a month during at least one year. if there are no recurrences of a-Fib’s , a discontinuation can be discussed with the patient. if there are doubts about recurrences, then the patient should get an external event recorder to analyze the suspect episodes.
according to the actual guidelines of the european society of cardiology, patients should be told to palpate their pulse frequently.
the autor pointed out that in the end the patient take the decision.
for patients with a higher score > 2, age > 75 years and stroke should continue the anticoagulation indefinitely, even if there are no recurrences.
he also pointed out that his comments only apply to patients with catheter ablation, data about surgical ablation are minimal, therefore evidence based conclusions are currently not possible.
referring to my situation: for the time being I continue the anticoagulation and measure my BP and pulse rate very regularly. extrasystoles occur frequently, although I don’t feel them. I want to be careful, so I delayed my decision whether to stop or not.


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Thanks for posting this new info @yoanne. I’m tagging @predictable and @debbee on this discussion since you have been talking with them about this in the past. I’m sure they’ll be interested in your findings.

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