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Do patients who have ablation or surgery for atrial fibrillation still need anticoagulation?
Restoring sinus rhythm, resecting the left atrial appendage, and transcatheter closure of the left atrial appendage opening have thus far not demonstrated a sufficient reduction of stroke risk to warrant discontinuing anticoagulation.
Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) found that restoring sinus rhythm did not reduce stroke risk.
The Watchman trial similarly did not find a reduction in stroke risk; additional device trials are ongoing.
The Left Atrial Appendage Occlusion Study III is an ongoing phase 3 trial comparing surgical excision of the left atrial appendage with best medical therapy.
At this time, anticoagulation is the only intervention proven to reduce stroke in the setting of atrial fibrillation.
Sources
Chimowitz MI, Lynn MJ, Derdeyn CP, Turan TN, Fiorella D, Lane BF, et al.: Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 365(11):993-1003, 2011.
