[AF-FRENCH-FORUM] 27E Anticoagulation après ablation d'AF. Dr. Moreira

[ATRIAL FIBRILLATION SYMPOSIUM]

Chers collègues,

Le fait de maintenir ou non la prévention du thromboembolisme après une 
ablation AF réussie, reste controversé pour moi.
Il n'y a pas de données scientifiques fiables sur laquelle fonder une 
décision.
Comme le collègue Marcos Sousa l'a bien dit, nous devons considérer le 
score CHADS, la présence de l'habitude de fumer, la technique utilisée 
pendant l'ablation (PV ou LL), les marqueurs comme le niveau du dimère d 
après l'ablation, le risque d'embolisme silencieux, etc.
J'aimerais écouter d'autres opinions pour décider ma conduite dans la 
vie réelle.
Merci beaucoup,

Felipe Moreira
Brésil

> 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
>