Oral Anticoagulation Discontinuation following Catheter Ablation of
Typical Atrial Flutter
Introduction: Catheter ablation (CA) of typical atrial flutter (AFl) is
the preferred treatment for typical AFl due to excellent long-term
success. However, current guidelines recommend oral anticoagulation
(OAC) based on established indices of stroke regardless of the perceived
success of ablation. Methods: We identified all patients who underwent
typical AFl ablation at our institute from 2011-2017. All patients
continued OAC for at least 6 weeks post CA and underwent 24-hour Holter
monitoring. OAC was discontinued if there was no evidence of recurrence
at 6 weeks. In patients with low LVEF or prior Atrial Fibrillation
episodes, OAC was continued for 6 months with repeat Holter monitoring
at 6 months. Results: A total of 106 patients were included in our
analysis, mean age was 64±14 years and 78.3% were male. Mean CHADSVaSC
score was 3±1. OAC was discontinued by 6 weeks in 17% and at 1 year in
55.7%. OAC 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 was a total of 3 major bleeding events, all in the OAC group.
Conclusion: In patients undergoing successful atrial flutter ablation, a
strategy of OAC discontinuation with close rhythm monitoring appears
feasible. Benefit of continued OAC in this cohort may be outweighed by
the adverse risk of bleeding. Further studies examining rhythm guided
OAC can minimize unnecessary exposure to long term anticoagulation.