P3857Is it safe to withdraw oral anticoagulation after successful cavotricuspid isthmus ablation regardless of the CHA2DS2-VASc?

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Background: CavoTricuspid Isthmus (CTI) ablation is well established as the definite treatment for Typical Atrial Flutter (TAF). Nevertheless, special concern arises about the management of oral anticoagulation (OAC) after ablation because of the incidence of new onset Atrial Fibrillation (nAFib) in those patients. Purpose: To analyse the incidence of nAFib and stroke after effective CTI ablation. To identify predictors for the incidence of nAFib or atrial flutter, in order to more safely select those patients who would benefit from OAC discontinuation. Method: Prospective analysis of a series of consecutive patients after successful CTI ablation from 2006 to 2014 followed until 2017, in our institution. Results: Among the initial 258 patients included, we analysed 71 cases (mean age 67±10 years; 31% women) with a CHA2DS2-VASc score ≥1 for men and ≥2 for women (mean 3.3±1.5) and no records of AFib or any other indication for anticoagulation rather than TAF, so OAC had been ended one month after ablation. Of them, 73% were hypertensive, 29% obese, 5% alcohol abusers, 18% diabetics, 28% had coronary artery disease, 8% obstructive sleep apnoea syndrome, 14% chronic obstructive pulmonary disease, 1.4% stroke, and 14% congestive heart failure. The mean HAS-BLED score was 1.7±1.1. During the follow-up (mean of 79±33 months; from 12 to 138 months), 22 developed nAFib (31%) and 5 atypical atrial flutter (7%), with no predictors observed; in all cases OAC was initiated. TAF recurred in 4 patients (6%) and after re-ablation OAC was removed again in all but in one patient because of atypical flutter previously diagnosed. Three suffered stroke (4%), having a median CHA2DS2-VASc score of 3 (IQ25–75:1–3). None of them were on anticoagulation at the moment of the event, and in only one case nAFib was diagnosed. OAC discontinuation resulted in a 0.38% annual stroke rate and 66% of the patients did not require anticoagulation at the end of the follow-up.

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