[AF-FORUM] 20P Anticoagulação após ablação de FA

[ATRIAL FIBRILLATION SYMPOSIUM]

Caros colegas,

eu também tenho dúvidas sobre a anticoagulação após ablação com sucesso 
de pacientes com escore CHADS 2. Esta minha breve participação é apenas 
para agradecer aos organizadores e solicitar mais comentários sobre o 
assunto. Graças a este simpósio fiquei sabendo desta excelente referência:

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 em 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.

Thank you very much,

Marcos Sousa - Belo Horizonte - Brasil
http://socios.cardiol.br/mrsousa