[AF-FRENCH-FORUM] 20P Anticoagulation après ablation d'AF. Dr. Sousa

[ATRIAL FIBRILLATION SYMPOSIUM]

Chers collègues,

J'ai aussi des doutes sur l'anticoagulation après une ablation réussie 
chez des patients ayant un Score CHADS 2. Mon petit apport est seulement 
pour remercier les organisateurs et pour demander plus de commentaires 
sur ce sujet. Merci au symposium, j'ai trouvé cette référence excellente:


1: Circulation. 2006 Aug 22;114(8):759-65. Epub 2006 Aug 14. Risk of
thromboembolic events after percutaneous left atrial radiofrequency
ablation of atrial fibrillation. Oral H, Chugh A, Ozaydin M, Good E, 
Fortino J,
Sankaran S, Reich S, Igic P, Elmouchi D, Tschopp D, Wimmer A, Dey S,
Crawford T, Pelosi F Jr, Jongnarangsin K, Bogun F, Morady F. Division of
Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
oralh at umich.edu

BACKGROUND: In patients with atrial fibrillation (AF), the risk of
thromboembolic events (TEs) is variable and is influenced by the
presence and number of comorbid conditions. The effect of
percutaneous left atrial radiofrequency ablation (LARFA) of AF on the
risk of TEs is unclear. METHODS AND RESULTS: LARFA was performed in
755 consecutive patients with paroxysmal (n = 490) or chronic (n =
265) AF. Four hundred eleven patients (56%) had > or = 1 risk factor
for stroke. All patients were anticoagulated with warfarin for > or =
3 months after LARFA. A TE occurred in 7 patients (0.9%) within 2
weeks of LARFA. A late TE occurred 6 to 10 months after ablation in 2
patients (0.2%), 1 of whom still had AF, despite therapeutic
anticoagulation in both. Among 522 patients who remained in sinus
rhythm after LARFA, warfarin was discontinued in 79% of 256 patients
without risk factors and in 68% of 266 patients with > or = 1 risk
factor. Patients older than 65 years or with a history of stroke were
more likely to remain anticoagulated despite a successful outcome
from LARFA. None of the patients in whom anticoagulation was
discontinued had a TE during 25 +/- 8 months of follow-up.
CONCLUSIONS: The risk of a TE after LARFA is 1.1%, with most events
occurring within 2 weeks after the procedure. Discontinuation of
anticoagulant therapy appears to be safe after successful LARFA, both
in patients without risk factors for stroke and in patients with risk
factors other than age > 65 years and history of stroke. Sufficient
safety data are as yet unavailable to support discontinuation of
anticoagulation in patients older than 65 years or with a history of
stroke.

Dr. Sousa
Brazil