Management of oral anticoagulation after pulsed field ablation for atrial fibrillation: Insights from a multicenter study.

BACKGROUND

The endothelial injury that can promote thrombus formation during radiofrequency ablation (RFA) of atrial fibrillation does not occur with pulsed field ablation (PFA).

OBJECTIVE

The purpose of this study was to evaluate different strategies for oral anticoagulation (OAC) management following PFA and RFA.

METHODS

Consecutive patients undergoing PFA were propensity score matched with consecutive patients undergoing RFA during the same time period (1:1) and prospectively followed up for 15 months. Based on the duration of OAC therapy, patients were classified into PFA/RFA-group 1 (OAC for 1 month) and PFA/RFA-group 2 (OAC for ≥2 months).

RESULTS

A total of 800 patients were included in this analysis: 400 from the PFA population (PFA-group 1: 196; PFA-group 2: 204) and 400 from the RFA population 400 (RFA-group 1: 182; RFA-group 2:218). At follow-up, none of the patients in PFA-group 1 (0%) and 2 patients (0.98%) in PFA-group 2 experienced stroke or transient ischemic attack (TIA). In the RFA cohort, 23 stroke/TIA were reported; 16 (8.8%) and 7 (3.2%) in group 1 and 2 respectively (p=0.017). Compared to the PFA population, total number of events were significantly higher in the overall RFA cohort (0.50% vs 5.8%, p <0.001) as well as in RFA-group 1 (0% vs 8.8%, p<0.001). Arrhythmia-recurrence at 15-month was detected in 73 (18.25%) and 108 (27.0%) (27.4%) patients in the PFA and RFA cohort respectively (p=0.003)

CONCLUSION

In this consecutive series, no stroke/TIA were reported in the PFA population after discontinuation of OAC at 1 month, whereas a significantly higher number of strokes were documented after OAC interruption at 1 month in the RFA group.