Letter from the Editor in Chief

DOI: 10.19102/icrm.2021.120707

MOUSSA MANSOUR, MD, FHRS, FACC

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Dr. Mansour reports the reception of research grants from Abbott Laboratories, Biosense Webster, Johnson & Johnson, Boston Scientific, Medtronic, Pfizer, Boehringer Ingelheim, and SentreHeart. He is also a consultant for Abbott Laboratories, Biosense Webster, Johnson & Johnson, Boston Scientific, Janssen, Medtronic, Phillips, Novartis, and SentreHeart and reports an equity relationship with EPS Solutions. All aforementioned relationships are in the area of atrial fibrillation; Dr. Mansour additionally reports an equity relationship in the area of ventricular fibrillation with NewPace Ltd.

Dear readers,

In this issue of The Journal of Innovations in Cardiac Rhythm Management, Alqam et al.¹ assess the discontinuation of anticoagulation after typical flutter ablation. Although retrospective and nonrandomized, their study offers important information that can help physicians managing patients with atrial flutter.

Meanwhile, no randomized studies have investigated the continuation versus cessation of oral anticoagulation after catheter ablation for atrial fibrillation (AF). A 2017 expert consensus statement on catheter and surgical ablation of AF² recommended adherence to AF anticoagulation in patients with a history of AF ablation, regardless of procedural success or failure. Continuous or frequent electrocardiographic monitoring to screen for AF recurrence should also be considered in patients in whom anticoagulation discontinuation is being weighed based on patient values and preferences.² Some well-designed nonrandomized studies^3–8 have found that catheter ablation for AF reduces the risk of stroke; stopping anticoagulation after successful ablation can also be safely accomplished in some patients if careful rhythm monitoring is performed.

The field of cardiac rhythm monitoring has rapidly expanded in recent years. I believe the discontinuation of anticoagulation after AF ablation can be safely accomplished in selected patients when paired with careful rhythm monitoring; however, randomized clinical studies that consider different monitoring practices and groups of patients remain critical.

Sincerely,

Moussa Mansour, MD, FHRS, FACC

Editor in Chief

The Journal of Innovations in Cardiac Rhythm Management

MMansour@InnovationsInCRM.com

Director, Atrial Fibrillation Program

Jeremy Ruskin and Dan Starks Endowed Chair in Cardiology

Massachusetts General Hospital

Boston, MA 02114

References

1. Alqam BM, Von Edwins KN, Devabhaktuni S, Paydak H, Pothineni NVK. Oral anticoagulation discontinuation following catheter ablation of typical atrial flutter. J Innov Cardiac Rhythm Manage. 2021;12(7):4595–4598.
2. Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017;14(10):e275–e444. [CrossRef] [PubMed]
3. Oral H, Chugh A, Ozaydin M, et al. Risk of thromboembolic events after percutaneous left atrial radiofrequency ablation of atrial fibrillation. Circulation. 2006;114(8):759–765. [CrossRef] [PubMed]
4. Nademanee K, Schwab MC, Kosar EM, et al. Clinical outcomes of catheter substrate ablation for high-risk patients with atrial fibrillation. J Am Coll Cardiol. 2008;51(8):843–849. [CrossRef] [PubMed]
5. Themistoclakis S, Corrado A, Marchlinsk FE, et al. The risk of thromboembolism and need for oral anticoagulation after successful atrial fibrillation ablation. J Am Coll Cardiol. 2010;55(8):735–743. [CrossRef] [PubMed]
6. Saad EB, d’Avila A, Costa IP, et al. Very low risk of thromboembolic events in patients undergoing successful catheter ablation of atrial fibrillation with a CHADS2 score ≤ 3: a long-term outcome study. Circ Arrhythm Electrophysiol. 2011;4(5):615–621. [CrossRef] [PubMed]
7. Riley MP, Zado E, Hutchinson MD, et al. Risk of stroke or transient ischemic attack after atrial fibrillation ablation with oral anticoagulant use guided by ECG monitoring and pulse assessment. J Cardiovasc Electrophysiol. 2014;25(6):591–596. [CrossRef]
8. Liang JJ, Elafros MA, Mullen MT, et al. Anticoagulation use and clinical outcomes after catheter ablation in patients with persistent and longstanding persistent atrial fibrillation. J Cardiovasc Electrophysiol. 2018;29(6):823–832. [CrossRef] [PubMed]