Anticoagulation after Catheter Ablation of Atrial Fibrillation Guided by Implantable Cardiac Monitors
Anticoagulation after Catheter Ablation of Atrial Fibrillation Guided by Implantable Cardiac Monitors
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DOI：
10.1111/pace.12625
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发表时间：
2015-06-01
影响因子：
1.8
通讯作者：
Schreieck, Juergen
中科院分区：
文献类型：
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作者：
Zuern, Christine S.;Kilias, Antonios;Schreieck, Juergen
背景：对于CHADS（2）评分升高的患者，不建议在房颤（AF）导管消融术后停用口服抗凝剂（OAC）。然而，在这些患者中，当停用OAC时，血栓栓塞事件的发生率较低。我们介绍了一种基于植入式心脏监护仪（ICM）记录的AF负担的消融术后OAC中止算法。方法65例CHADS（2）评分1-3分的患者在消融术后3个月无AF（AF消融[n = 49]或可能的AF触发消融[n = 16]）。植入ICM后1天，停用OAC。患者每日询问ICM，如果每日AF负荷超过1小时，ICM被程控为向患者发出警报。研究终点是首次复发的每日AF负担1小时或血栓栓塞事件，这两个触发重新启动OAC.ResultsDuring随访时间为32 12个月（126患者年），41 65例（63%）有AF负担
BackgroundDiscontinuation of oral anticoagulation (OAC) after catheter ablation of atrial fibrillation (AF) is not recommended in patients with elevated CHADS(2) scores. However, a low incidence of thromboembolic events is reported when OAC is stopped in these patients. We introduce an algorithm for discontinuation of OAC after ablation based on the AF burden documented by implantable cardiac monitors (ICM).MethodsSixty-five patients with CHADS(2) scores 1-3 free from AF 3 months after ablation (AF ablation [n = 49] or ablation of possible AF triggers [n = 16]) were included. One day after implantation of the ICM, OAC was stopped. Patients performed a daily interrogation of the ICM which was programmed to alarm the patient if daily AF burden exceeded 1 hour. Study end point was the first recurrence of a daily AF burden 1 hour or a thromboembolic event, which both triggered reinitiation of OAC.ResultsDuring a follow-up time of 32 12 months (126 patient-years), 41 of the 65 patients (63%) had an AF burden