Efficacy of oral anticoagulation in stroke prevention: Among sinus-rhythm patients who lack left atrial mechanical contraction after cryoablation

José Martínez-Comendador, Javier Gualis, José Miguel Marcos-Vidal, Jonnatan Buber, Carlos Esteban Martín, Jesús Gomez-Plana, Miguel Angel Rodríguez, Ignacio Iglesias-Garriz, David Alonso, Carlos Soria, Eva Higuera Miguélez, Mario Castaño

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

The customary recommendation is that oral anticoagulation be withdrawn a few months after cryoablation for atrial fibrillation, independently of left atrial mechanical contraction in patients in sinus rhythm. Recently, a 5-fold increase in stroke has been described in sinusrhythm patients who lack atrial mechanical contraction. One aim of this study was to evaluate the efficacy of oral anticoagulation in preventing postoperative stroke in such patients. This prospective study divided 154 sinus-rhythm patients into 2 groups, depending on the presence (108 patients) or absence (46 patients) of left atrial mechanical contraction at 6 months after surgery, and monitored them annually for 5 years. Those without left atrial contraction were maintained on acenocumarol. The primary endpoint was the occurrence of ischemic stroke. The median follow-up period was 29 ± 16 months; 4 patients (2.5%), all belonging to the group with preserved atrial contraction, had ischemic stroke; the group of patients without left atrial contraction had no episodes of stroke during follow-up. Logistic binary regression analyses showed no evidence of factors independently predictive of stroke. Among anticoagulated patients in sinus rhythm without left atrial contraction, we found the incidence of stroke to be zero. In a small, nonrandomized group such as this, we cannot discount the element of chance, yet we suggest that maintaining anticoagulation might lower the incidence of stroke in this population.

Original languageEnglish
Pages (from-to)430-437
Number of pages8
JournalTexas Heart Institute Journal
Volume42
Issue number5
DOIs
StatePublished - Oct 2015
Externally publishedYes

Keywords

  • Ablation
  • Anticoagulants/therapeutic use
  • Atrial appendage/surgery
  • Atrial fibrillation/surgery
  • Atrial function, left
  • Catheter ablation
  • Cryosurgery/methods
  • Heart atria/surgery
  • Myocardial contraction
  • Prospective studies
  • Sinus rhythm
  • Stroke/prevention and control
  • Thromboembolism
  • Treatment outcome

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