CHA2DS2-VASc score-based anticoagulation management after catheter ablation for atrial fibrillation: a post-hoc analysis of the ALONE-AF trial
Y Lee, J S Uhm, J Park, D Kim, P S Yang, H T Yu, T H Kim, J Shim, E K Choi, I Y Oh, J Kim, J S Ko, K M Park, Y S Lee, B JoungAbstract
Background and Aims
Discontinuation of oral anticoagulant (OAC) therapy in patients without recurrent atrial arrhythmia after ablation for atrial fibrillation (AF) has recently been demonstrated to reduce composite outcomes of stroke, systemic embolism, and major bleeding than continued OAC therapy. This study aimed to evaluate the optimal OAC strategy according to baseline stroke risk and AF recurrence.
Methods
In this post-hoc analysis of the Long-Term Anticoagulation Discontinuation after Catheter Ablation for Atrial Fibrillation (ALONE-AF) randomized trial, patients were stratified according to a CHA2DS2-VASc score £2 (low-risk) and ≥3 (high-risk). The cumulative incidence of stroke, systemic embolism, and major bleeding at 2 years was estimated using the Kaplan–Meier method. Competing risk analysis accounting for AF recurrence was performed.
Results
Among 840 patients, 584 and 256 had a CHA2DS2-VASc score £2 (mean age 62.0±7.5 years, 15.9% female) and ≥3 (mean age 68.9±7.3 years, 45.3% female), respectively. In the low-risk group, the primary outcome occurred in one (0.4%) versus six patients (2.4%) (absolute difference -1.9 percentage points, P=0.066). In the high-risk group, two events (1.8%) occurred in the continuation subgroup only (absolute difference -1.8 percentage points, P=0.172). Five major bleeding events occurred in the continuation subgroup. Competing risk analysis yielded consistent results, with similar AF recurrence rates.
Conclusion
No statistically significant differences in outcomes were observed between OAC strategies when stratified by CHA2DS2-VASc score. These findings suggest that anticoagulation decisions after successful ablation may depend more on maintained arrhythmia-free status than baseline stroke risk alone, supporting individualized approaches with systematic monitoring.Cumulative incidence of primary outcomeSecondary outcomes at 2 years